Effects of a german asthma disease management program using sickness fund claims data.

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Windt, Roland; Glaeske, Gerd

2010-08-01

The purpose of this study was to assess outcomes of a nationwide asthma disease management (DM) program in Germany. A retrospective observational study with propensity-score matching was performed using claims data of sickness funds exclusively. Effects were analyzed on the basis of a match of 317 program participants and nonparticipants with similar propensity score and age. Hospitalization or oral corticosteroid user rates were comparable in both groups, whereas there are significantly more subjects in the DM group with a prescription of an inhaled corticosteroid and fewer with a prescription of a cromolyn/reproterol combination. There are also less "doctor hoppers" in the DM group, defined as subjects with antiasthmatic drug prescriptions of at least three physicians. The results suggest that the impact of a nationwide disease management program for asthma is weak in respect of clinically relevant endpoints, but there are indications that medication in a DM program approximates asthma guidelines more closely.

Concordance with a STOPP (Screening Tool of Older Persons' Potentially Inappropriate Prescriptions) Criterion in Nova Scotia, Canada: Benzodiazepine and Zoplicone Prescription Claims by Older Adults with Fall-related Hospitalizaions.

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Hill-Taylor, B; Sketris, I S; Gardner, D M; Thompson, K

2016-01-01

Optimization of prescribing in older adults is needed. The STOPP criteria provide a systematic way of identifying potentially inappropriate prescribing in this population. Previous research indicates poor concordance between benzodiazepine prescribing and STOPP. To determine the extent and predictors of benzodiazepine and zopiclone (BZD-Z) pharmacy dispensations in older adults with a history of a recent fall, in concordance with STOPP. Prescription claims data from the Nova Scotia Seniors' Phamacare Program were linked with fall-related injury data from the CIHI Discharge Abstract Database. Adults aged ≥ 66 years making a claim for a BZD-Z in the 100 days prior to fall-related hospitalization were identified. Their BZD-Z claims in the 100 days following discharge were also identified. Descriptive statistics, trend tests and logistical regression modelling were performed to examine predictors for continued use of BZD-Z post-fall. Over 5 years, from a pool of 8,271 older adults discharged following a fall-related hospitalization, 1,789 (21.6%) had made a claim for a BZD-Z in the 100 days prior to admission. Of these, 82% were women. Younger age and female sex were predictors of continuing BZD-Z dispensations post-fall. In the 100 days following discharge, 74.2% (n=1327) made a claim for at least one BZD-Z. BZD-Z use continued in 74% of patients following discharge from a fall-related hospitalization, representing limited concordance with the STOPP criterion. Such hospitalizations and follow-up care present an opportunity to address an ongoing modifiable risk factor.

Epidemiology of malpractice claims in the orthopedic and trauma surgery department of a French teaching hospital: A 10-year retrospective study.

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Agout, C; Rosset, P; Druon, J; Brilhault, J; Favard, L

2018-02-01

Orthopedic and trauma surgery is the specialty for which claims for compensation are most often filed. Little data exists on the subject in France, especially in a teaching hospital. We conducted a retrospective study aimed at (1) identifying the epidemiological characteristics of patients filing claims against the orthopedic surgery and traumatology department of a teaching hospital in France, (2) analyzing the surgical procedures involved, the type of legal proceedings, and the financial consequences. The epidemiological profile of proceedings seeking damages in France is consistent with the data from European and American studies. An observational, retrospective, single-center study of all claims for damages between 2007 and 2016 involving the orthopedic and trauma surgery department of a teaching hospital was carried out. Patients' epidemiological data, the surgical procedure, type of legal proceeding, and financial consequences were analyzed. Of the 51,582 surgical procedures performed, 71 claims (0.0014%) were analyzed (i.e., 1/726 procedures). A significant increase in the number of cases (p=0.040) was found over a 10-year period. Of these, 36/71 (53.7%) were submitted to the French regional conciliation and compensation commission (CRCI), 23/71 (32.8%) were filed with the administrative court, and 12/71 (13.4%) were submitted for an amicable settlement. The most common reason for which patients filed claims was hospital-acquired infections, with 36/71 (50.7%) cases. Twenty-nine complaints (40.8%) resulted in monetary damages being awarded to the patient, with an average award of € 28,301 (€ 2,400-299,508). Damage awards were significantly higher (pClaims against orthopedic surgeons have been increasing significantly over the last 10 years. Although rare, they represent a significant cost to society. Hospital-acquired infections are the main reason for disputes in our specialization. IV, retrospective study. Copyright © 2017 Elsevier Masson SAS. All

Using prescription registries to define continuous drug use: how to fill gaps between prescriptions

DEFF Research Database (Denmark)

Nielsen, Lars Hougaard; Løkkegaard, Ellen; Andreasen, Anne Helms

2008-01-01

Pharmacoepidemiological studies often use prescription registries to assess patients' drug episodes. The databases usually provide information on the date of the redemption of the prescription as well as on the dispensed amount, and this allows us to define episodes of drug use. However, when...... that the retrospective exposure definition introduces an artificially protective effect of HT....

Prescription patterns of enzyme-containing products in South Africa over a 2-year period

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Ilse Truter

2014-09-01

Full Text Available Enzymes are traded in five categories, namely medical (intervention, diagnostic (detection and quantification, molecular biology, biofuel and industrial. Therapeutic enzymes have been investigated for different uses, for example, for the treatment of genetic disorders, blood clotting disorders, cancer and infectious diseases and for burn debridement. No studies on the prescription of enzyme-containing products in South Africa could be found. Enzymes are classified in the Monthly Index of Medical Specialities under digestants, enzymes and fibrinolytics. The primary aim of this study was to investigate the prescription patterns and cost of enzyme-containing products in South Africa. A private health-care medicines claims database for 2010 and 2011 of approximately 4.5 million records was analysed retrospectively. Enzyme-containing products constituted a small percentage of medical insurance claims (only 0.02% of approximately 4.5 million claims for products and procedures, yet they were relatively expensive. A total of 906 products was prescribed at a cost of almost ZAR2 million over the 2 years. Hyaluronidase was the most frequently prescribed (60.04%, followed by pancreatin-containing products (34.66%. Pancreatin (lipase/ protease/amylase is primarily used in the management of pancreatic exocrine insufficiency. The average cost per hyaluronidase prescription paid by the medical insurance schemes was ZAR280. Other enzyme-containing products prescribed were imiglucerase, alteplase and tenecteplase. Imiglucerase was overall the most expensive. Alteplase, tenecteplase and streptokinase are antithrombotic enzymes that are used in the treatment of acute myocardial infarction or ischaemic stroke. Streptokinase, regarded as the most affordable antithrombotic enzyme, was not prescribed during the period under study. With the growing opportunities for enzymes for therapeutics, the use of enzyme-containing products which are comparatively expensive require

Treatment patterns in multiple sclerosis: administrative claims analysis over 10 years.

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Oleen-Burkey, MerriKay; Cyhaniuk, Anissa; Swallow, Eric

2013-01-01

Treatment patterns for the MS disease-modifying therapies (DMT) have changed over time. The objective of this study was to examine and describe treatment patterns in MS over a 10-year period. MS patients who filled a DMT prescription between January 1, 2001 and December 31, 2010 were identified from Clinformatics for DataMart affiliated with OptumInsight. Two cohorts were identified: those with a DMT prescription in 2003 and those with a DMT prescription in 2008. Treatment patterns were examined 2 years before and after the anchor prescriptions for each cohort. Comparing treatment patterns prior to the two anchor prescriptions, interferon-beta (IFNβ)-1a IM (Avonex) and IFNβ-1b (Betaseron) gained the most users in 2001-2003, while IFNβ-1a IM and IFNβ-1a SC (Rebif) gained the most users from 2006-2008. In the 2 years following the two anchor prescriptions, treatment patterns changed. From 2003-2005, 21.2% of IFNβ-1a SC users and more than 15.0% of IFNβ-1a IM and IFNβ-1b users changed to another interferon or glatiramer acetate (GA; Copaxone), while 12.5% of GA users changed to an interferon, most often IFNβ-1a SC. From 2008-2010 the largest proportion of changes from each of the interferons and natalizumab (NZ; Tysabri) were to GA, while those switching from GA were most often changed to IFNβ-1a SC. Those with a 2008 anchor prescription for NZ were most often changed (57%) to GA. In retrospective database analyses the presence of a claim for a filled prescription does not indicate that the drug was consumed, and reasons for changes in therapy are not available. The study design looking forward and backward from the anchor prescriptions may have contributed to differences in the proportion of patients seen with no observable change in DMT. Claims-based data are also constrained by coverage limitations that determine the data available and limit the generalizability of results to managed care patients. Changes in treatment patterns in the first half of the

Opioid tapering in patients with prescription opioid use disorder: A retrospective study.

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Zhou, Kehua; Jia, Peng; Bhargava, Swati; Zhang, Yong; Reza, Taslima; Peng, Yuan Bo; Wang, Gary G

2017-10-01

Opioid use disorder (OUD) refers to a maladaptive pattern of opioid use leading to clinically significant impairment or distress. OUD causes, and vice versa, misuses and abuse of opioid medications. Clinicians face daily challenges to treat patients with prescription opioid use disorder. An evidence-based management for people who are already addicted to opioids has been identified as the national priority in the US; however, options are limited in clinical practices. In this study, we aimed to explore the success rate and important adjuvant medications in the medication assisted treatment with temporary use of methadone for opioid discontinuation in patients with prescription OUD. This is a retrospective chart review performed at a private physician office for physical medicine and rehabilitation. We reviewed all medical records dated between December 1st, 2011 and August 30th, 2016. The initial evaluation of the included patients (N=140) was completed between December 1st, 2011 and December 31st, 2014. They all have concumittant prescription OUD and chronic non-cancer pain. The patients (87 female and 53 male) were 46.7±12.7 years old, and had a history of opioid use of 7.7±6.1 years. All patients received the comprehensive opioid taper treatments (including interventional pain management techniques, psychotherapy, acupuncture, physical modalities and exercises, and adjuvant medications) on top of the medication assisted treatment using methadone (transient use). Opioid tapering was considered successful when no opioid medication was used in the last patient visit. The 140 patients had pain of 9.6±8.4 years with 8/10 intensity before treatment which decreased after treatment in all comparisons (pOUD. For patients with OUD, indefinite opioid maintenance treatment may not be necessary. Considering the ethical values of autonomy, nonmaleficence, and beneficence, clinicians should provide patients with OUD the option of opioid tapering. Copyright © 2017

Do coxibs reduce prescription of gastroprotective agents? Results of a record linkage study

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Violante Andrea

2006-03-01

Full Text Available Abstract Background Coxibs are claimed to be cost-effective drugs and reduced prescription of gastroprotective agents is assumed to be one of their major benefits. Real life prescription of these drugs may be substantially different than that considered in pharmacoeconomic analyses or claimed by drug companies, yet. Our objective was to evaluate whether coxibs were associated with reduced prescription of gastro-protective agents (GPAs, specifically proton pump inhibitors, H2 blockers and misoprostol compared to non selective NSAIDs. Methods A record-linkage study was performed using 2001 outpatient prescription data from the province of Modena (about 632,000 inhabitants, in Northern Italy. Logistic regression was used to calculate the odds ratio of GPA prescription for coxib and non-selective NSAID adult users (> 14 years. Three categories of users were further investigated: "acute", "chronic and "incident or new". Main outcome measures were same-day co-prescription and 30 days prescription of GPAs in coxibs and non selective NSAIDs users. To limit selection bias, data were adjusted for age, sex, DDD of coxibs and non selective NSAIDs received during 2001, DDD of GPAs and (for non-incident users DDD of NSAIDs received during the previous 4 years Results Same day co-prescription rates were similar considering the overall population and "acute" users. Chronic coxibs users instead showed higher co-prescription rates than chronic NSAIDs users (OR = 1.2, p Conclusion Assumptions made in pharmacoeconomic analyses on coxibs (lower GPA prescription associated with coxibs use may be overly optimistic. Claims made through cost-effectiveness data should be carefully interpreted, and mechanisms for attributing drug prices revised accordingly.

One-year risk of psychiatric hospitalization and associated treatment costs in bipolar disorder treated with atypical antipsychotics: a retrospective claims database analysis

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Pikalov Andrei

2011-01-01

Full Text Available Abstract Background This study compared 1-year risk of psychiatric hospitalization and treatment costs in commercially insured patients with bipolar disorder, treated with aripiprazole, ziprasidone, olanzapine, quetiapine or risperidone. Methods This was a retrospective propensity score-matched cohort study using the Ingenix Lab/Rx integrated insurance claims dataset. Patients with bipolar disorder and 180 days of pre-index enrollment without antipsychotic exposure who received atypical antipsychotic agents were followed for up to 12 months following the initial antipsychotic prescription. The primary analysis used Cox proportional hazards regression to evaluate time-dependent risk of hospitalization, adjusting for age, sex and pre-index hospitalization. Generalized gamma regression compared post-index costs between treatment groups. Results Compared to aripiprazole, ziprasidone, olanzapine and quetiapine had higher risks for hospitalization (hazard ratio 1.96, 1.55 and 1.56, respectively; p Conclusions In commercially insured adults with bipolar disorder followed for 1 year after initiation of atypical antipsychotics, treatment with aripiprazole was associated with a lower risk of psychiatric hospitalization than ziprasidone, quetiapine, olanzapine and risperidone, although this did not reach significance with the latter. Aripiprazole was also associated with significantly lower total healthcare costs than quetiapine, but not the other comparators.

Direct-to-consumer advertising of prescription drugs.

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Frosch, Dominick L; Grande, David

2010-01-01

In 2007, the pharmaceutical industry spent more than $4.9 billion on direct-to-consumer advertising (DTCA) of prescription drugs in the U.S. Controversy over DTCA has grown since the Food and Drug Administration liberalized its regulations in 1997. Proponents claim that such advertising educates consumers, promotes patient participation in clinical decisions, and improves patient adherence to medication instructions. Opponents argue that such advertising is meant to persuade, not educate, and that it promotes inappropriate use of prescription drugs, or diverts consumers from better alternatives. This Issue Brief summarizes the evidence about the effects of DTCA, and proposes guidelines for improving the utility of prescription drug advertising.

A 12-year analysis of closed medical malpractice claims of the Taiwan civil court: A retrospective study.

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Hwang, Chi-Yuan; Wu, Chien-Hung; Cheng, Fu-Cheng; Yen, Yung-Lin; Wu, Kuan-Han

2018-03-01

Malpractices lawsuits cause increased physician stress and decreased career satisfaction, which might result in defensive medicine for avoiding litigation. It is, consequently, important to learn experiences from previous malpractice claims. The aim of this study was to examine the epidemiologic factors related to medical malpractice claims, identify specialties at high risk of such claims, and determine clinical which errors tend to lead to medical malpractice lawsuits, by analyzing closed malpractice claims in the civil courts of Taiwan.The current analysis reviewed the verdicts of the Taiwan judicial system from a retrospective study using the population-based databank, focusing on 946 closed medical claims between 2002 and 2013.Among these medical malpractice claims, only 14.1% of the verdicts were against clinicians, with a mean indemnity payment of $83,350. The most common single specialty involved was obstetrics (10.7%), while the surgery group accounted for approximately 40% of the cases. In total, 46.3% of the patients named in the claims had either died or been gravely injured. Compared to the $75,632 indemnity for deceased patients, the mean indemnity payment for plaintiffs with grave outcomes was approximately 4.5 times higher. The diagnosis groups at high risk of malpractice litigation were infectious diseases (7.3%), malignancies (7.2%), and limb fractures (4.9%). A relatively low success rate was found in claims concerning undiagnosed congenital anomalies (4.5%) and infectious diseases (5.8%) group. A surgery dispute was the most frequent argument in civil malpractice claims (38.8%), followed by diagnosis error (19.3%).Clinicians represent 85.9% of the defendants who won their cases, but they spent an average of 4.7 years to reach final adjudication. Increased public education to prevent unrealistic expectations among patients is recommended to decrease frivolous lawsuits. Further investigation to improve the lengthy judicial process is also

Prescriptions of Chinese Herbal Medicine for Constipation Under the National Health Insurance in Taiwan

OpenAIRE

Maw-Shiou Jong; Shinn-Jang Hwang; Yu-Chun Chen; Tzeng-Ji Chen; Fun-Jou Chen; Fang-Pey Chen

2010-01-01

Constipation is a common gastrointestinal problem worldwide. The aim of this study was to determine the frequency of use and prescriptive patterns of Chinese herbal medicine (CHM) in treating constipation by analyzing the claims data of traditional Chinese medicine (TCM) from the National Health Insurance (NHI) in Taiwan. Methods: The computerized claims dataset of the TCM office visits and the corresponding prescription files in 2004 compiled by the NHI Research Institute in Taiwan were l...

Community pharmacy and mail order cost and utilization for 90-day maintenance medication prescriptions.

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Khandelwal, Nikhil; Duncan, Ian; Rubinstein, Elan; Ahmed, Tamim; Pegus, Cheryl

2012-04-01

Pharmacy benefit management (PBM) companies promote mail order programs that typically dispense 90-day quantities of maintenance medications, marketing this feature as a key cost containment strategy to address plan sponsors' rising prescription drug expenditures. In recent years, community pharmacies have introduced 90-day programs that provide similar cost advantages, while allowing these prescriptions to be dispensed at the same pharmacies that patients frequent for 30-day quantities. To compare utilization rates and corresponding costs associated with obtaining 90-day prescriptions at community and mail order pharmacies for payers that offer equivalent benefits in different 90-day dispensing channels. We performed a retrospective, cross-sectional investigation using pharmacy claims and eligibility data from employer group clients of a large PBM between January 2008 and September 2010. We excluded the following client types: government, third-party administrators, schools, hospitals, 340B (federal drug pricing), employers in Puerto Rico, and miscellaneous clients for which the PBM provided billing services (e.g., the pharmacy's loyalty card program members). All employer groups in the sample offered 90-day community pharmacy and mail order dispensing and received benefits management services, such as formulary management and mail order pharmacy, from the PBM. We further limited the sample to employer groups that offered equivalent benefits for community pharmacy and mail order, defined as groups in which the mean and median copayments per claim for community and mail order pharmacy, by tier, differed by no more than 5%. Enrollees in the sample were required to have a minimum of 6 months of eligibility in each calendar year but were not required to have filled a prescription in any year. We evaluated pharmacy costs and utilization for a market basket of 14 frequently dispensed therapeutic classes of maintenance medications. The proportional share of claims for

A retrospective audit of antibiotic prescriptions in primary health-care facilities in Eastern Region, Ghana

DEFF Research Database (Denmark)

Ahiabu, Mary-Anne; Tersbøl, Britt Pinkowski; Biritwum, Richard

2016-01-01

with the national average estimated in 2008. Interventions that reduce diagnostic uncertainty in illness management should be considered. The National Health Insurance Scheme, as the main purchaser of health services in Ghana, offers an opportunity that should be exploited to introduce policies in support......Resistance to antibiotics is increasing globally and is a threat to public health. Research has demonstrated a correlation between antibiotic use and resistance development. Developing countries are the most affected by resistance because of high infectious disease burden, limited access to quality...... assured antibiotics and more optimal drugs and poor antibiotic use practices. The appropriate use of antibiotics to slow the pace of resistance development is crucial. The study retrospectively assessed antibiotic prescription practices in four public and private primary health-care facilities in Eastern...

Prescription Opioid Usage and Abuse Relationships: An Evaluation of State Prescription Drug Monitoring Program Efficacy

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Richard M. Reisman

2009-01-01

Full Text Available Context The dramatic rise in the use of prescription opioids to treat non-cancer pain has been paralleled by increasing prescription opioid abuse. However, detailed analyses of these trends and programs to address them are lacking. Objective To study the association between state shipments of prescription opioids for medical use and prescription opioid abuse admissions and to assess the effects of state prescription drug monitoring programs (PDMPs on prescription opioid abuse admissions. Design and Setting A retrospective ecological cohort study comparing state prescription opioid shipments (source: Automation of Reports and Consolidated Orders Systems database and inpatient admissions for prescription opioid abuse (source: Treatment Episode Data Set in 14 states with PDMPs (intervention group and 36 states without PDMPs (control group for the period 1997–2003. Results From 1997 to 2003, oxycodone, morphine, and hydrocodone shipments increased by 479%, 100%, and 148% respectively. Increasing prescription oxycodone shipments were significantly associated with increasing prescription opioid admission rates (p < 0.001. PDMP states had significantly lower oxycodone shipments than the control group. PDMP states had less increase in prescription opioid admissions per year (p = 0.063. A patient admitted to an inpatient drug abuse rehabilitation program in a PDMP state was less likely to be admitted for prescription opioid drug abuse (Odds ratio = 0.775, 95% Confidence Interval 0.764–0.785. Conclusions PDMPs appear to decrease the quantity of oxycodone shipments and the prescription opioid admission rate for states with these programs. Overall, opioid shipments rose significantly in PDMP states during the study period indicating a negligible “chilling effect” on physician prescribing.

Completeness of retail pharmacy claims data: implications for pharmacoepidemiologic studies and pharmacy practice in elderly patients.

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Polinski, Jennifer M; Schneeweiss, Sebastian; Levin, Raisa; Shrank, William H

2009-09-01

In the elderly (those aged >or=65 years), retail pharmacy claims are used to study drug use among the uninsured after drug policy changes, to prevent drug-drug interactions and duplication of therapy, and to guide medication therapy management. Claims include only prescriptions filled at 1 pharmacy location or within 1 pharmacy chain and do not include prescriptions filled at outside pharmacies, potentially limiting research accuracy and pharmacy-based safety interventions. The aims of this study were to assess elderly patients' pharmacy loyalty and to identify predictors of using multiple pharmacies. Patients enrolled in the Pharmaceutical Assistance Contract for the Elderly (PACE) pharmacy benefit program with corresponding Medicare claims in the state of Pennsylvania comprised the study cohort. Among patients with pharmacy claims from all pharmacies used in 2004-2005, a primary pharmacy was defined as the pharmacy where at least 50% of a patient's prescriptions were filled. The number of pharmacies/chains used and prescriptions filled in 2005 was calculated. Predictors of using multiple pharmacies in 2005 were age, female gender, white race, urban residency, comorbidities, number of distinct chemical drugs (unique medications) used, and number of prescriptions filled, which were all assessed in 2004. In total, pharmacy claims data from 182,116 patients (147,718 women [81.1%]; mean [SD] age, 78.8 [7.1] years; 168,175 white [92.3%]; 76,580 [42.1%] residing in an urban zip code area) were included. Of the 182,116 PACE patients in the study, a primary pharmacy was identified for 180,751 patients (99.3%). In 2005, patients filled an average of 59.3 prescriptions, with 57.0 prescriptions (96.1%) having been filled at the primary pharmacy. Compared with patients who used or=15 unique medications had a 2.66 times (95% CI, 2.53-2.80) greater likelihood of using multiple pharmacies in 2005. Patients aged >or=85 years were 1.07 times (95% CI, 1.04-1.11) as likely to use

Completeness of Retail Pharmacy Claims Data: Implications for Pharmacoepidemiologic Studies and Pharmacy Practice in Elderly Adults

Science.gov (United States)

Polinski, Jennifer M.; Schneeweiss, Sebastian; Levin, Raisa; Shrank, William H.

2009-01-01

Background In the elderly (those aged ≥65 years), retail pharmacy claims are used to study drug use among the uninsured after drug policy changes, to prevent drug drug interactions and duplication of therapy, and to guide medication therapy management. Claims include only prescriptions filled at one pharmacy location or within one pharmacy chain and do not include prescriptions filled at outside pharmacies, potentially limiting research accuracy and pharmacy-based safety interventions. Objectives The aims of this study were to assess elderly patients’ pharmacy loyalty and to identify predictors of using multiple pharmacies. Methods Patients enrolled in the Pharmaceutical Assistance Contract for the Elderly pharmacy benefit program with corresponding Medicare claims in the state of Pennsylvania comprised the study cohort. Among patients with pharmacy claims from all pharmacies used in 2004–2005, a primary pharmacy was defined as the pharmacy where >50% of a patient’s prescriptions were filled. The number of pharmacies/chains used and prescriptions filled in 2005 was calculated. Predictors of using multiple pharmacies in 2005 were age, gender, race, urban residency, comorbidities, number of unique medications used, and number of prescriptions, which were all assessed in 2004. Results In total, pharmacy claims data from 182,235 patients (147,718 [81.1%] women; mean [SD] age 78.8 [7.1] years; 168,175 white; 76,580 residing in an urban zip code area) were included. In 2005, patients filled an average of 59.3 prescriptions, with 57.0 (96.1%) prescriptions having been filled at the primary pharmacy. Compared with patients who used <5 unique medications in 2004, patients who used 6 to 9 unique medications had 1.39 times (95% CI, 1.34–1.44), and patients who used 15 unique medications had 2.68 times (95% CI, 2.55–2.82) greater likelihood of using multiple pharmacies in 2005. Patients aged ≥85 years were 1.07 times (95% CI, 1.03–1.11) as likely to use

Musculoskeletal pain: prescription of NSAID and weak opioid by primary health care physicians in Sweden 2004–2008 – a retrospective patient record review

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Metha Brattwall

2010-08-01

Full Text Available Metha Brattwall1, Ibrahim Turan2, Jan Jakobsson31Department of Anaesthesia, Institute for Clinical Sciences at Sahlgrenska Academy, Mölndal Hospital, Gothenburg, Sweden; 2Foot and Ankle Surgical Centre, Stockholm, Sweden; 3Karolinska Institutet, Institution for Physiology and Pharmacology, Department of Anaesthesia, Stockholm, SwedenPurpose: To study the prescription of oral analgesics for musculoskeletal pain by primary care physicians over a 5-year period in Sweden.Design: A retrospective automatic database review of patient records at four primary health care centers. All prescriptions of NSAIDs, weak opioids, and coprescriptions of gastroprotecting medications to patients with musculoskeletal were retrieved for the period January 1, 2004 to November 11, 2008.Results: A total of 27,067 prescriptions prescribed to 23,457 patients with musculoskeletal pain were analyzed. Of all prescriptions, NSAIDs were the most commonly prescribed analgesic comprising 79%, tramadol was the second most commonly prescribed analgesic comprising 9%, codeine the third most (7%, and dextropropoxyphene the fourth (5%. The proportion of NSAIDs and weak opioids and the proportion of the different weak opioids prescribed showed no change over time. The proportion of nonselective and selective NSAIDs prescribed changed; Coxib prescriptions decreased from 9% to 4% of all analgesics prescribed in 2004–2007 with no change in 2008.Conclusion: NSAIDs were found to be the dominant class of analgesic prescribed by primary care physicians to patients diagnosed as musculoskeletal pain. No change was observed in the proportion of NSAID and weak opioid prescription over the period studied. Prescription of selective Coxibs decreased and was less than 4% in 2008. The impact on gastrointestinal and cardiovascular adverse effects associated with the extensive prescription of NSAIDS for musculoskeletal pain warrants further analysis.Keywords: nonsteroidal anti-inflammatory drugs

Impact of a direct-to-consumer information campaign on prescription patterns for overactive bladder.

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Zaitsu, Masayoshi; Yoo, Byung-Kwang; Tomio, Jun; Nakamura, Fumiaki; Toyokawa, Satoshi; Kobayashi, Yasuki

2018-05-03

Direct-to-consumer information (DTCI) campaign is a new medium to inform and empower patients in their decision-making without directly promoting specific drugs. However, little is known about the impact of DTCI campaigns, expanding rapidly in developed countries, on changes in prescription patterns. We sought to determine whether a DTCI campaign on overactive bladder increases the prescription rate for overactive bladder treatment drugs. We performed a 3-year retrospective cohort study of 1332 participants who were diagnosed overactive bladder but not prescribed treatment drugs prior to the examined DTCI campaign (exposure), using the health insurance claims dataset of the Japan Medical Data Center (November 19, 2010 to November 18, 2013). The DTCI campaign for overactive bladder included television, Internet, and print advertising (November 19, 2011 to December 22, 2011). We divided the study period into Pre-Campaign Year (2010-2011), Year 1 (2011-2012), and Year 2 (2012-2013). Each year began on November 19 and included Period 1 (weeks 1-5) through Period 10 (weeks 46-50). The main outcome was first-time prescription of the treatment drug for each patient, measured by 5-week periods. Using Period 10 in the Pre-Campaign Year as the referent period, we applied the Cox proportional hazard model for each period. Additionally, we performed the interrupted time series analysis (ITSA) for the first-time prescription rate per 5-week period. Following the DTCI campaign, patients were about seven times more likely to receive a first prescription of a treatment drug during Period 4 in Year 1 (hazard ratio 7.09; 95% CI, 2.11-23.8; p-valueimpact on the level of prescription rate (one-time increase in the regression-intercept) that increased by 1128.1 [per standardized 100,000 persons] (p < .05) during Period 4 in Year 1. The examined DTCI campaign appeared to increase the prescription rate among patients with overactive bladder for 15 weeks with a 15-week delay. Clinical

Therapeutic inertia and intensified treatment in diabetes mellitus prescription patterns: A nationwide population-based study in Taiwan.

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Huang, Li-Ying; Yeh, Hseng-Long; Yang, Ming-Chin; Shau, Wen-Yi; Su, Syi; Lai, Mei-Shu

2016-12-01

Objective To measure therapeutic inertia by characterizing prescription patterns using secondary data obtained from the nationwide diabetes mellitus pay-for-performance (DM-P4P) programme in Taiwan. Methods Using reimbursement claims from Taiwan's National Health Insurance Research Database, a nationwide retrospective cohort study was undertaken of patients with diabetes mellitus who participated in the DM-P4P programme from 2006-2008. Glycosylated haemoglobin results were used to evaluate modifications in therapy in response to poor diabetes control. Prescription patterns were used to assign patients to either a therapeutic inertia group or an intensified treatment group. Therapeutic inertia was defined as the failure to act on a known problem. Results The research sample comprised of 168 876 patients with diabetes mellitus who had undergone 899 135 tests. Of these, 37.4% (336 615 visits) of prescriptions were for a combination of two types of drug and 27.7% (248 788 visits) were for a combination of three types of drug. The proportion of patients in the intensified therapy group who were prescribed more than two types of drug was considerably higher than that in the therapeutic inertia group. Conclusion In many cases in the therapeutic inertia group only a single type of hypoglycaemic drug was prescribed or the dosage remained unchanged.

High Generic Drug Prices and Market Competition: A Retrospective Cohort Study.

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Dave, Chintan V; Kesselheim, Aaron S; Fox, Erin R; Qiu, Peihua; Hartzema, Abraham

2017-08-01

Prices for some generic drugs have increased in recent years, adversely affecting patients who rely on them. To determine the association between market competition levels and the change in generic drug prices in the United States. Retrospective cohort study. Prescription claims from commercial health plans between 2008 and 2013. The 5.5 years of data were divided into 11 study periods of 6 months each. The Herfindahl-Hirschman Index (HHI)-calculated by summing the squares of individual manufacturers' market shares, with higher values indicating a less competitive market-and average drug prices were estimated for the generic drugs in each period. The HHI value estimated in the baseline period (first half of 2008) was modeled as a fixed covariate. Models estimated price changes over time by level of competition, adjusting for drug shortages, market size, and dosage forms. From 1.08 billion prescription claims, a cohort of 1120 generic drugs was identified. After adjustment, drugs with quadropoly (HHI value of 2500, indicating relatively high levels of competition), duopoly (HHI value of 5000), near-monopoly (HHI value of 8000), and monopoly (HHI value of 10 000) levels of baseline competition were associated with price changes of -31.7% (95% CI, -34.4% to -28.9%), -11.8% (CI, -18.6% to -4.4%), 20.1% (CI, 5.5% to 36.6%), and 47.4% (CI, 25.4% to 73.2%), respectively, over the study period. Study findings may not be generalizable to drugs that became generic after 2008. Market competition levels were associated with a change in generic drug prices. Such measurements may be helpful in identifying older prescription drugs at higher risk for price change in the future. None.

Persistence with weekly and monthly bisphosphonates among postmenopausal women: analysis of a US pharmacy claims administrative database

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Fan T

2013-11-01

Full Text Available Tao Fan, Qiaoyi Zhang, Shuvayu S Sen Global Health Outcomes, Merck, Whitehouse Station, NJ, USA Background: Bisphosphonates are available in daily, weekly, and monthly dosing formulations to treat postmenopausal osteoporosis. Some researchers suggested that adherence to monthly bisphosphonate might be different from that with weekly or daily bisphosphonate because of different dosing regimens. However, the actual persistency rates in regular practice settings are unknown. Objectives: To compare persistence rates with alendronate 70 mg once weekly (AOW, risedronate 35 mg once weekly (ROW, and ibandronate 150 mg once monthly (IOM in a US pharmacy claims database. Methods: In this retrospective cohort study, pharmacy claims data of patients with new bisphosphonate prescriptions were extracted for women aged ≥ 50 years who had an AOW, ROW, or IOM prescription (index prescription between December 30, 2004 and May 31, 2005 (the index period and did not have the index Rx during the previous 12 months. Patients’ records were reviewed for at least 5 months from their index date to November 2, 2005 (the follow-up period. Patients were considered persistent if they neither discontinued (failed to refill the index Rx within a 45-day period following the last supply day of the previous dispensing nor switched (changed to another bisphosphonate during the follow-up period. Medication-possession ratio was defined as days with index prescription supplies/total days of follow-up. Results: Among 44,635 patients, 25,207 (56.5% received prescriptions of AOW, 18,689 (41.9% ROW, and 739 (1.7% IOM as the index prescription. In all, 35.1% of AOW patients, 32.5% of ROW patients, and 30.4% of IOM patients (P < 0.0001 AOW vs ROW or IOM had persisted with their initial therapy, whereas 64.0% of AOW, 66.4% of ROW, and 68.2% of IOM patients discontinued (P < 0.0001 during follow-up. The medication-possession ratio (days with index prescription supplies/total days of

Prescriptions for schedule II opioids and benzodiazepines increase after the introduction of computer-generated prescriptions.

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McGerald, Genevieve; Dvorkin, Ronald; Levy, David; Lovell-Rose, Stephanie; Sharma, Adhi

2009-06-01

Prescriptions for controlled substances decrease when regulatory barriers are put in place. The converse has not been studied. The objective was to determine whether a less complicated prescription writing process is associated with a change in the prescribing patterns of controlled substances in the emergency department (ED). The authors conducted a retrospective nonconcurrent cohort study of all patients seen in an adult ED between April 19, 2005, and April 18, 2007, who were discharged with a prescription. Prior to April 19, 2006, a specialized prescription form stored in a locked cabinet was obtained from the nursing staff to write a prescription for benzodiazepines or Schedule II opioids. After April 19, 2006, New York State mandated that all prescriptions, regardless of schedule classification, be generated on a specialized bar-coded prescription form. The main outcome of the study was to compare the proportion of Schedule III-V opioids to Schedule II opioids and benzodiazepines prescribed in the ED before and after the introduction of a less cumbersome prescription writing process. Of the 26,638 charts reviewed, 2.1% of the total number of prescriptions generated were for a Schedule II controlled opioid before the new system was implemented compared to 13.6% after (odds ratio [OR] = 7.3, 95% confidence interval [CI] = 6.4 to 8.4). The corresponding percentages for Schedule III-V opioids were 29.9% to 18.1% (OR = 0.52, 95% CI = 0.49 to 0.55) and for benzodiazepines 1.4% to 3.9% (OR = 2.8, 95% CI = 2.4 to 3.4). Patients were more likely to receive a prescription for a Schedule II opioid or a benzodiazepine after a more streamlined computer-generated prescription writing process was introduced in this ED. (c) 2009 by the Society for Academic Emergency Medicine.

Association of prescription abandonment with cost share for high-cost specialty pharmacy medications.

Science.gov (United States)

Gleason, Patrick P; Starner, Catherine I; Gunderson, Brent W; Schafer, Jeremy A; Sarran, H Scott

2009-10-01

In 2008, specialty medications accounted for 15.1% of total pharmacy benefit medication spending, and per member expenditures have increased by 11.1% annually from 2004 to 2008 within a commercially insured population of 8 million members. Insurers face increasing pressure to control specialty medication expenditures and to rely on increasing member cost share through creation of a fourth copayment tier within the incentive-based formulary pharmacy benefit system. Data are needed on the influence that member out-of-pocket (OOP) expense may have on prescription abandonment (defined as the patient never actually taking possession of the medication despite evidence of a written prescription generated by a prescriber). To explore the relationship between prescription abandonment and OOP expense among individuals newly initiating high-cost medication therapy with a tumor necrosis factor (TNF) blocker or multiple sclerosis (MS) biologic agent. This observational cross-sectional study queried a midwestern and southern U.S. database of 13,172,480 commercially insured individuals to find members with a pharmacy benefit-adjudicated claim for a TNF blocker or MS specialty medication during the period from July 2006 through June 2008. Prescription abandonment was assessed among continuously enrolled members newly initiating TNF blocker or MS therapy. Prescription abandonment was defined as reversal of the adjudicated claim with no evidence of a subsequent additional adjudicated paid claim in the ensuing 90 days. Separate analyses for MS and TNF blocker therapy were performed to assess the association between member OOP expense and abandonment rate using the Cochran-Armitage test for trend and multivariate logistic regression. Members were placed into 1 of the 7 following OOP expense groups per claim: $0-$100, $101-$150, $151-$200, $201-$250, $251-$350, $351-$500, or more than $500. The association of MS or TNF blocker abandonment rate with OOP expense was tested with logistic

Characteristics of claims in the management of septic arthritis in Japan: Retrospective analyses of judicial precedents and closed claims.

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Otaki, Yasuhiro; DaSilva, Makiko Ishida; Saito, Yuichi; Oyama, Yasuaki; Oiso, Giichiro; Yoshida, Tomohiko; Fukuhara, Masakazu; Moriyama, Mitsuru

2018-03-01

Septic arthritis (SA) cases can result in claims or litigation because of poor prognosis even if it is unavoidable. Although these claims or litigation are useful for understanding causes and background factors of medical errors, the characteristics of malpractice claims associated with SA remain undetermined in Japan. This study aimed to increase our understanding of malpractice claims in the clinical management of SA. We analyzed 6 civil precedents and 16 closed claims of SA from 8530 malpractice claims processed between July 2004 and June 2014 by the Tokyo office of Sompo Japan Nipponkoa Insurance, Incorporated. We also studied 5 accident and 21 incident reports of SA based on project data compiled by the Japan Council for Quality Health Care. The rate of negligence was 83.3% in the precedents and 75.0% in closed claims. Two main malpractice claim patterns were revealed: SA in a lower extremity joint following sepsis caused by methicillin-resistant Staphylococcus aureus in newborns and SA in an injection site following joint injection. These two patterns accounted for 83.3% and 56.3% of judicial cases and closed claim cases, respectively. Breakdowns in care process of accident and incident reports were clearly differentiated from judicial cases or closed claim cases (Fisher's exact test, p < 0.001). It is important to pay particular attention to SA following sepsis in newborns and to monitor for any signs of SA after joint injection to ensure early diagnosis. Analysis of both malpractice claims and accident and incident reports is essential to ensure a full understanding of the situation in Japan. Copyright © 2017. Published by Elsevier Taiwan LLC.

Prescription Monitoring Program Trends Among Individuals Arrested in Maine for Trafficking Prescription Drugs in 2014.

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McCall, Kenneth; Nichols, Stephanie D; Holt, Christina; Ochs, Leslie; Cattabriga, Gary; Tu, Chunhao

2016-06-01

To evaluate controlled substance prescribing trends available in the Maine Prescription Monitoring Program (PMP) among individuals arrested for prescription drug "trafficking." The demographic characteristics of the individuals who had matching prescription records in the PMP within 90 days of the arrest were identified. A population-based, retrospective cohort study using data from the Maine Diversion Alert Program (DAP) and the Maine PMP. The study population consisted of persons arrested for trafficking prescription drugs in Maine during the 2014 calendar year from January 1 to December 31. There were 594 trafficking arrests reported by the Maine DAP in 2014. The study population consisted of the 235 persons (40%) with arrests involving controlled prescription medications. The mean age of these persons was 33 years (range 18-77 yrs), and 156 (66%) were male. Arrests involved 154 prescription opioids (65%), seven stimulants (3%), seven benzodiazepines (3%), and 77 unspecified controlled prescription drugs (33%). A minority of individuals (n=57, 24%) had a prescription record in the PMP that matched the substance involved in the arrest. Only one person with matching PMP and arrest records utilized ≥ 5 prescribers, while none used ≥ 5 pharmacies within 90 days before the arrest. Payment methods for matching prescriptions were commercial insurance (n=28, 49%), Medicaid (n=19, 33%), Medicare (n=5, 9%), and cash (n=5, 9%). The majority (76%) of persons arrested for prescription drug trafficking did not have PMP records and did not directly obtain the diverted medication from a licensed pharmacy. Traditional red flags, like cash payment and using multiple prescribers or pharmacies, were uncommon. Therefore, arrest records for diversion and PMPs are distinct and complementary tools for identifying individuals at risk for substance misuse. © 2016 Pharmacotherapy Publications, Inc.

Retapamulin prescriptions and monitored off-label use.

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Mundy, Linda M; Sampson, Tim; Logie, John W

2014-08-01

Retapamulin, a topical pleuromutilin that selectively inhibits bacterial protein synthesis, is approved for treatment of impetigo and secondarily infected traumatic lesions in adults and in children older than 9 months of age. A 5-year study was conducted to monitor prescription use in children younger than 9 months of age. Annual prescription events were monitored in the UK Clinical Practice Research Datalink (CPRD) and the Clinformatics™ DataMart Multiplan (IMPACT), a product of OptumInsight Life Sciences, Inc. (Eden Prairie, MN, USA), from the USA. In the CPRD, of 148 prescriptions, three (2 %) were identified in children aged less than 9 months between years 2008 and 2011. In IMPACT, of 59,210 claims for retapamulin in children, 1,951 (3.3 %) were categorized as definitive, or uncertain for, less than 9 months of age between 2007 and 2011. Retapamulin prescription events in children aged less than 9 months were relatively low compared with other recent estimations of off-label pediatric medicines. Our report provides a framework for future investigations and discussions that may facilitate off-label reporting schemes and promote pediatric drug safety.

Frequency and pattern of Chinese herbal medicine prescriptions for chronic hepatitis in Taiwan.

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Chen, Fang-Pey; Kung, Yen-Ying; Chen, Yu-Chun; Jong, Maw-Shiou; Chen, Tzeng-Ji; Chen, Fun-Jou; Hwang, Shinn-Jang

2008-04-17

Chinese herbal medicine (CHM) has been commonly used in treating liver diseases in Asian countries. To conduct a large-scale pharmacoepidemiological study and evaluate the frequency and pattern of CHM prescriptions in treating chronic hepatitis. We obtained the database of traditional Chinese medicine outpatient claims from the national health insurance in Taiwan for the whole 2002. Patients with chronic hepatitis were identified by the corresponding diagnosis of International Classification of Disease among claimed visiting files. Corresponding prescription files were analyzed, and association rule were applied to evaluate the co-prescription of CHM in treating chronic hepatitis. Among the 91,080 subjects treated by CHM for chronic hepatitis, the peak age was in the 40 s, followed by 30 s and 50 s. Male/female ratio was 2.07:1. Long-dan-xie-gan-tang and Saliva miltiorrhiza (Dan-shen) were the most commonly prescribed Chinese herbal formula and single herbal drug, respectively. The most common two-drug prescription was Jia-wei-xia-yao-san plus Saliva miltiorrhiza, and the most common three-drug prescription was Jia-wei-xia-yao-san plus Saliva miltiorrhiza and Artemisia capillaries (Yin-chen-hao). This study showed the utilization pattern of Chinese herbal drugs or formulae in treating chronic hepatitis. Further researches and clinical trials are needed to evaluate the efficacy of these Chinese herbs or its ingredients in treating chronic hepatitis.

Opioid prescriptions before and after high-energy trauma

DEFF Research Database (Denmark)

Zwisler, Stine T; Hallas, Jesper; Larsen, Morten S

2015-01-01

OBJECTIVE: To describe the legal use of opioids in adult patients before and after high-energy trauma. DESIGN: The study was a retrospective database study. SETTING: Clinical care outside hospitals. PATIENTS: All patients who suffered high-energy trauma and were brought to Odense University...... Hospital (OUH), Denmark, in 2007 and 2008 were retrieved from the trauma database. These patients were linked with data on opioid use from the regional prescription database. In all, 938 patients were included. MAIN OUTCOME MEASURE: Redemption of opioid prescription during the 6 months prior...... to a multitrauma or redemption of two or more prescriptions for opioids 6 months or later after a multitrauma. RESULTS: Of the 938 patients brought to OUH with severe trauma within the study period, 61 patients died (7 percent) and six of these had redeemed prescriptions for opioids within 6 months prior...

Can purchasing information be used to predict adherence to cardiovascular medications? An analysis of linked retail pharmacy and insurance claims data.

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Krumme, Alexis A; Sanfélix-Gimeno, Gabriel; Franklin, Jessica M; Isaman, Danielle L; Mahesri, Mufaddal; Matlin, Olga S; Shrank, William H; Brennan, Troyen A; Brill, Gregory; Choudhry, Niteesh K

2016-11-09

The use of retail purchasing data may improve adherence prediction over approaches using healthcare insurance claims alone. Retrospective. A cohort of patients who received prescription medication benefits through CVS Caremark, used a CVS Pharmacy ExtraCare Health Care (ECHC) loyalty card, and initiated a statin medication in 2011. We evaluated associations between retail purchasing patterns and optimal adherence to statins in the 12 subsequent months. Among 11 010 statin initiators, 43% were optimally adherent at 12 months of follow-up. Greater numbers of store visits per month and dollar amount per visit were positively associated with optimal adherence, as was making a purchase on the same day as filling a prescription (ppurchase variables had low discriminative ability (C-statistic: 0.563), while models with both clinical and retail purchase variables achieved a C-statistic of 0.617. While the use of retail purchases may improve the discriminative ability of claims-based approaches, these data alone appear inadequate for adherence prediction, even with the addition of more complex analytical approaches. Nevertheless, associations between retail purchasing behaviours and adherence could inform the development of quality improvement interventions. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

[Changes in prescription patterns for peripheral and cerebral vasoactive drugs before and after establishing prescription standards in France].

Science.gov (United States)

Vuittenez, F; Guignard, E; Comte, S

1999-01-23

1995 and 15.8% after promulgation of the prescription standards, p > 0.1). For the treatment of lower limb arteritis, prescription costs fell by a mean 9% per prescription and for the treatment of cerebrovascular disease they rose by a mean 7% per prescription. The price rise, due to multiple prescriptions of vasoactive drugs was 190 FF per prescription for lower limb arteritis and 104 FF per prescription for cerebrovascular disease. Despite the retrospective nature of this study where confounding factors could not be controlled, our findings are in agreement with those reported earlier suggesting that cost containment policy implemented by the prescription standards has had little efficacy. In patients with arterial disease of the lower limbs, the percentage of prescriptions not complying with the recommended standards decreased by one-third to one-half over a 2-year period since the prescription standards were first announced in 1994.

Study on drug costs associated with COPD prescription medicine in Denmark

DEFF Research Database (Denmark)

Jakobsen, M; Anker, N; Dollerup, J

2013-01-01

that the costs associated with COPD in Denmark are significant, but costs of prescription medicine for COPD were not analysed. OBJECTIVES: To analyse the societal costs associated with prescription medicine for COPD in Denmark. METHODS: The study was designed as a nationwide retrospective register study...... in 2010 with total costs of DKK 685 million (EUR 92 million). The average lifetime costs associated with COPD prescription medicine were estimated to be DKK 70,000-75,000 (EUR 9,416-10,089) per patient (2010 prices). CONCLUSION: The costs associated with prescription medicine for COPD in Denmark...... of the drug costs (ATC group R03) associated with COPD in the period 2001-2010. Data were retrieved from the Prescription Database, the National Patient Register and the Centralised Civil Register. The population comprised individuals (40+ years) who had at least one prescription of selected R03 drugs and who...

STUDY ON DRUG COSTS ASSOCIATED WITH COPD PRESCRIPTION MEDICINE IN DENMARK

DEFF Research Database (Denmark)

Jakobsen, Iris Marie; Anker, Niels; Dolleru, Jens

2012-01-01

that the costs associated with COPD in Denmark are significant, but costs of prescription medicine for COPD were not analysed. OBJECTIVES: To analyse the societal costs associated with prescription medicine for COPD in Denmark. METHODS: The study was designed as a nationwide retrospective register study...... in 2010 with total costs of DKK 685 million (EUR 92 million). The average lifetime costs associated with COPD prescription medicine were estimated to be DKK 70,000-75,000 (EUR 9,416-10,089) per patient (2010 prices). CONCLUSION: The costs associated with prescription medicine for COPD in Denmark...... of the drug costs (ATC group R03) associated with COPD in the period 2001-2010. Data were retrieved from the Prescription Database, the National Patient Register and the Centralised Civil Register. The population comprised individuals (40+ years) who had at least one prescription of selected R03 drugs and who...

Positive predictive value between medical-chart body-mass-index category and obesity versus codes in a claims-data warehouse.

Science.gov (United States)

Caplan, Eleanor O; Kamble, Pravin S; Harvey, Raymond A; Smolarz, B Gabriel; Renda, Andrew; Bouchard, Jonathan R; Huang, Joanna C

2018-01-01

To evaluate the positive predictive value of claims-based V85 codes for identifying individuals with varying degrees of BMI relative to their measured BMI obtained from medical record abstraction. This was a retrospective validation study utilizing administrative claims and medical chart data from 1 January 2009 to 31 August 2015. Randomly selected samples of patients enrolled in a Medicare Advantage Prescription Drug (MAPD) or commercial health plan and with a V85 claim were identified. The claims-based BMI category (underweight, normal weight, overweight, obese class I-III) was determined via corresponding V85 codes and compared to the BMI category derived from chart abstracted height, weight and/or BMI. The positive predictive values (PPVs) of the claims-based BMI categories were calculated with the corresponding 95% confidence intervals (CIs). The overall PPVs (95% CIs) in the MAPD and commercial samples were 90.3% (86.3%-94.4%) and 91.1% (87.3%-94.9%), respectively. In each BMI category, the PPVs (95% CIs) for the MAPD and commercial samples, respectively, were: underweight, 71.0% (55.0%-87.0%) and 75.9% (60.3%-91.4%); normal, 93.8% (85.4%-100%) and 87.8% (77.8%-97.8%); overweight, 97.4% (92.5%-100%) and 93.5% (84.9%-100%); obese class I, 96.9 (90.9%-100%) and 97.2% (91.9%-100%); obese class II, 97.0% (91.1%-100%) and 93.0% (85.4%-100%); and obese class III, 85.0% (73.3%-96.1%) and 97.1% (91.4%-100%). BMI categories derived from administrative claims, when available, can be used successfully particularly in the context of obesity research.

Prescription History of Emergency Department Patients Prescribed Opioids

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Jason A Hoppe

2013-05-01

Full Text Available Introduction: To use Colorado’s prescription drug monitoring program (PDMP to describe the recent opioid prescription history of patients discharged from our emergency department (ED with a prescription for opioid pain medications.Methods: Retrospective cohort study of 300 adult ED patients who received an opioid prescription. We abstracted prescription histories for the six months prior to the ED visit from the PDMP, and abstracted clinical and demographic variables from the chart.Results: There were 5,379 ED visits during the study month, 3,732 of which were discharged. Providers wrote 1,165 prescriptions for opioid analgesics to 1,124/3,732 (30% of the patients. Median age was 36 years. Thirty-nine percent were male. Patients were 46% Caucasian, 26% African American, 22% Hispanic, 2% Asian and 4% other. These were similar to our overall ED population. There was substantial variability in the number of prescriptions, prescribers and total number of pills. A majority (205/296 of patients had zero or one prescription. The 90th percentile for number of prescriptions was seven, while the 10th percentile was zero. Patients in the highest decile tended to be older, with a higher proportion of Caucasians and females. Patients in the lowest decile resembled the general ED population. The most common diagnoses associated with opioid prescriptions were abdominal pain (11.5%, cold/flu symptoms (9.5%, back pain (5.4%, flank pain (5.0% and motor vehicle crash (4.7%.Conclusion: Substantial variability exists in the opioid prescription histories of ED patients, but a majority received zero or one prescription in the preceding six months. The top decile of patients averaged more than two prescriptions per month over the six months prior to ED visit, written by more than 6 different prescribers. There was a trend toward these patients being older, Caucasian and female. [West J Emerg Med. 2013;14(3:247–252.

Effect of EHR user interface changes on internal prescription discrepancies.

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Turchin, A; Sawarkar, A; Dementieva, Y A; Breydo, E; Ramelson, H

2014-01-01

To determine whether specific design interventions (changes in the user interface (UI)) of an electronic health record (EHR) medication module are associated with an increase or decrease in the incidence of contradictions between the structured and narrative components of electronic prescriptions (internal prescription discrepancies). We performed a retrospective analysis of 960,000 randomly selected electronic prescriptions generated in a single EHR between 01/2004 and 12/2011. Internal prescription discrepancies were identified using a validated natural language processing tool with recall of 76% and precision of 84%. A multivariable autoregressive integrated moving average (ARIMA) model was used to evaluate the effect of five UI changes in the EHR medication module on incidence of internal prescription discrepancies. Over the study period 175,725 (18.4%) prescriptions were found to have internal discrepancies. The highest rate of prescription discrepancies was observed in March 2006 (22.5%) and the lowest in March 2009 (15.0%). Addition of "as directed" option to the dropdown decreased prescription discrepancies by 195 / month (p = 0.0004). An non-interruptive alert that reminded providers to ensure that structured and narrative components did not contradict each other decreased prescription discrepancies by 145 / month (p = 0.03). Addition of a "Renew / Sign" button to the Medication module (a negative control) did not have an effect in prescription discrepancies. Several UI changes in the electronic medication module were effective in reducing the incidence of internal prescription discrepancies. Further research is needed to identify interventions that can completely eliminate this type of prescription error and their effects on patient outcomes.

The association of consumer cost-sharing and direct-to-consumer advertising with prescription drug use.

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Hansen, Richard A; Schommer, Jon C; Cline, Richard R; Hadsall, Ronald S; Schondelmeyer, Stephen W; Nyman, John A

2005-06-01

Previous research on the impact of various cost-sharing strategies on prescription drug use has not considered the impact of direct-to-consumer (DTC) advertising. To explore the association of cost-containment strategies with prescription drug use and to determine if the association is moderated by DTC prescription drug advertising. The study population included 288 280 employees and dependents aged 18 to 65 years with employer-sponsored health insurance contributing to the MEDSTAT MarketScan administrative data set. Person-level enrollment and claims data were obtained for beneficiaries enrolled continuously during July 1997 through December 1998. Direct-to-consumer advertising data were obtained from Competitive Media Reporting and linked to the MEDSTAT enrollment files. Localized DTC advertising expenditures for one class of medication were evaluated and matched with prescription claims for eligible MEDSTAT contributors. The association of various types and levels of cost-sharing incentives with incident product use was evaluated, controlling for the level of DTC advertising, health status, and other demographic covariates. The relationship of cost-sharing amounts with drug use was modified by the level of DTC advertising in a geographic market. This relationship was dependent on the type of cost-sharing, distinguishing between co-payments for provider visits and co-payments for prescription drugs. Compared with low-advertising markets, individuals residing in markets with high levels of advertising and paying provider co-payments of $10.00 or more were more likely to use the advertised product. In the same markets, higher prescription drug co-payments were associated with a decreased likelihood of using the advertised product. A similar relationship was not observed for the nonadvertised competitor. Among insured individuals, response to cost-sharing strategies is moderated by DTC prescription drug advertising. The relative ability of cost-sharing strategies to

Frequency and co-prescription pattern of Chinese herbal products for hypertension in Taiwan: a Cohort study

OpenAIRE

Yang, Pei-Rung; Shih, Wei-Tai; Chu, Yen-Hua; Chen, Pau-Chung; Wu, Ching-Yuan

2015-01-01

Background Chinese herbal products (CHPs) have been frequently used among patients with chronic diseases including hypertension; however, the co-prescription pattern of herbal formulae and single herbs remain uncharacterized. Thus, this large-scale pharmacoepidemiological study evaluated the frequency and co-prescription pattern of CHPs for treating hypertension in Taiwan from 2003 to 2009. Methods The database of traditional Chinese medicine (TCM) outpatient claims was obtained from the Nati...

Changes of the prescription of hormone therapy in menopausal women: An observational study in Taiwan

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Hsiao Fei-Yuan

2007-04-01

Full Text Available Abstract Background To evaluate the impact of the 2002 Women's Health Initiative (WHI study results on the prescription of menopausal hormone therapy (MHT to treat menopause-related symptoms in Taiwan. Methods This retrospective study participant data collected from women interviewed in 2001 Taiwan's National Health Interview Survey (NHIS and the National Health Insurance (NHI outpatient claims for women being treated for menopause-related symptoms. We compared prescriptions made for MHI to women seeking outpatient treatment for menopause-related symptoms before and after the publication of the 2002 WHI to study its effect of prescription behavior in Taiwan. There was one dichotomous outcome variable, which was whether MHT was prescribed or not in an outpatient visit to treat menopause-related symptoms. Results Our study included 504 women 45 years old or above whose outpatient visits for menopause-related symptoms were covered by National Health Insurance in 2002. In total, these 504 women made 2549 outpatient visits to be treated for these symptoms. The proportion of outpatient visits in which MHT was prescribed dropped from 83.0% (n = 1,155 before WHI to 73.0% (n = 844 after WHI. We found a decrease in likelihood that women would be prescribed MHT for menopause-related symptoms after the release of the WHI report (OR = 0.36, 95%CI = 0.25 to 0.52, p Conclusion The WHI report caused a substantial decline in the use of MHT to treat menopause-related symptoms in Taiwan. It was found to exert most of its influence in patients with higher educations, physicians with specialties other than gynecologists and obstetricians, and academic medical centers.

Prescriptions of Chinese Herbal Medicines for Insomnia in Taiwan during 2002

Science.gov (United States)

Chen, Fang-Pey; Jong, Maw-Shiou; Chen, Yu-Chun; Kung, Yen-Ying; Chen, Tzeng-Ji; Chen, Fun-Jou; Hwang, Shinn-Jang

2011-01-01

Chinese herbal medicine (CHM) has been commonly used for treating insomnia in Asian countries for centuries. The aim of this study was to conduct a large-scale pharmaco-epidemiologic study and evaluate the frequency and patterns of CHM use in treating insomnia. We obtained the traditional Chinese medicine (TCM) outpatient claims from the National Health Insurance in Taiwan for the year 2002. Patients with insomnia were identified from the diagnostic code of International Classification of Disease among claimed visiting files. Corresponding prescription files were analyzed, and an association rule was applied to evaluate the co-prescription of CHM. Results showed that there were 16 134 subjects who visited TCM clinics for insomnia in Taiwan during 2002 and received a total of 29 801 CHM prescriptions. Subjects between 40 and 49 years of age comprised the largest number of those treated (25.3%). In addition, female subjects used CHMs for insomnia more frequently than male subjects (female : male = 1.94 : 1). There was an average of 4.8 items prescribed in the form of either an individual Chinese herb or formula in a single CHM prescription for insomnia. Shou-wu-teng (Polygonum multiflorum) was the most commonly prescribed single Chinese herb, while Suan-zao-ren-tang was the most commonly prescribed Chinese herbal formula. According to the association rule, the most commonly prescribed CHM drug combination was Suan-zao-ren-tang plus Long-dan-xie-gan-tang, while the most commonly prescribed triple drug combination was Suan-zao-ren-tang, Albizia julibrissin, and P. multiflorum. Nevertheless, further clinical trials are needed to evaluate the efficacy and safety of these CHMs for treating insomnia. PMID:19339485

Effect of EHR User Interface Changes on Internal Prescription Discrepancies

Science.gov (United States)

Sawarkar, A.; Dementieva, Y.A.; Breydo, E.; Ramelson, H.

2014-01-01

Summary Objective To determine whether specific design interventions (changes in the user interface (UI)) of an electronic health record (EHR) medication module are associated with an increase or decrease in the incidence of contradictions between the structured and narrative components of electronic prescriptions (internal prescription discrepancies). Materials and Methods We performed a retrospective analysis of 960,000 randomly selected electronic prescriptions generated in a single EHR between 01/2004 and 12/2011. Internal prescription discrepancies were identified using a validated natural language processing tool with recall of 76% and precision of 84%. A multivariable autoregressive integrated moving average (ARIMA) model was used to evaluate the effect of five UI changes in the EHR medication module on incidence of internal prescription discrepancies. Results Over the study period 175,725 (18.4%) prescriptions were found to have internal discrepancies. The highest rate of prescription discrepancies was observed in March 2006 (22.5%) and the lowest in March 2009 (15.0%). Addition of „as directed“ option to the dropdown decreased prescription discrepancies by 195 / month (p = 0.0004). An non-interruptive alert that reminded providers to ensure that structured and narrative components did not contradict each other decreased prescription discrepancies by 145 / month (p = 0.03). Addition of a „Renew / Sign“ button to the Medication module (a negative control) did not have an effect in prescription discrepancies. Conclusions Several UI changes in the electronic medication module were effective in reducing the incidence of internal prescription discrepancies. Further research is needed to identify interventions that can completely eliminate this type of prescription error and their effects on patient outcomes. PMID:25298811

Antibiotic prescription patterns for upper respiratory tract infections in the outpatient Qatari population in the private sector.

Science.gov (United States)

Butt, Adeel Ajwad; Navasero, Cristina S; Thomas, Bright; Marri, Salih Al; Katheeri, Huda Al; Thani, Asmaa Al; Khal, Abdullatif Al; Khan, Tasnim; Abou-Samra, Abdul-Badi

2017-02-01

Antibiotics are often inappropriately prescribed for upper respiratory tract infections (URTIs) in developed countries. Data on the proportion of inappropriate prescriptions are lacking from the Middle East and other developing countries. Health insurance claims for all antibiotics prescribed for URTIs in the private sector in the State of Qatar between May 2014 and December 2015 were retrieved. During the study period, health insurance was limited to Qatari nationals. Topical antibiotics were excluded. Data on the prescriber's specialty, as listed with the licensing authority, were also retrieved. Diagnoses were classified as appropriate or inappropriate based on the likelihood of a bacterial etiology that may warrant antibiotic use. A total of 75 733 claims were made during the study period. Of these, 41 556 (55%) were for an appropriate indication, while 34 177 (45%) were for an inappropriate indication. The most common antibiotic classes prescribed were cephalosporins (43% of claims; 44% inappropriate), penicillins (28% of claims; 44% inappropriate), macrolides (19% of claims; 52% inappropriate), and fluoroquinolones (9% of claims; 40% inappropriate). Nearly 5% of antibiotics were prescribed in intravenous formulations. The most common prescribers were General/Family Practice physicians (53% of claims; 50% inappropriate), followed by Pediatrics (18.6% of claims; 36% inappropriate) and Internal Medicine (14.1% of claims; 44% inappropriate). There is a high rate of inappropriate antibiotic prescription for acute URTIs in the private health care sector in the State of Qatar. Further studies are needed to determine the population-based rates across the country. Interventions to decrease inappropriate use in such settings are urgently needed. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Influence of errors in prescriptions on the security of medicine

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Puke K.

2016-01-01

Full Text Available All types of medication errors including missed doses, incorrect dosage forms, time intervals, and routes are essential encumbrances for qualitative pharmaceutical care and security of medicine [1]. Problems related to prescription errors are common in the healthcare profession, and are responsible for significant increase in costs, cases of morbidity and mortality [2]. The aim of the study was to analyze the common errors in prescriptions which were received in pharmacies and their effect on the security of medicine. Retrospective study was conducted between December 2013 and January 2014 in the pharmacy of Riga, Latvia. Prescriptions were analyzed to identify errors in Inscriptio, Praescriptio and the Signatura part. Of 200 prescriptions, only 14 (7% were filled correctly according to the legislative requirements in Latvia. The most common drug therapeutic class in the prescriptions was non-steroidal anti-inflammatory drugs (NSAID and other analgesics (21.1%. Unclear handwriting was observed in more than one third of all studied prescriptions (n=72; 36.0%. Mean age values of physicians were higher, but not significantly different, in the unclear compared to clear prescriptions, 59.5 ± 8.5 vs. 57.8 ± 10.6, respectively (p=0.253. Omission of the quantity of drug in the prescription part was the most frequent type of the error (n=112, 56.0%. High level of incorrect prescriptions was found during the period of study in the pharmacy. Overall, approximately 27% of prescriptions had significant failures, which could negatively affect therapeutic effect and safety of drug use.

Opioid tapering in patients with prescription opioid use disorder : A retrospective study

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Zhou, Kehua; Jia, Peng; Bhargava, Swati; Zhang, Yong; Reza, Taslima; Peng, Yuan Bo; Wang, Gary G.

2017-01-01

Background and aims: Opioid use disorder (OUD) refers to a maladaptive pattern of opioid use leading to clinically significant impairment or distress. OUD causes, and vice versa, misuses and abuse of opioid medications. Clinicians face daily challenges to treat patients with prescription opioid use

A smart medication recommendation model for the electronic prescription.

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Syed-Abdul, Shabbir; Nguyen, Alex; Huang, Frank; Jian, Wen-Shan; Iqbal, Usman; Yang, Vivian; Hsu, Min-Huei; Li, Yu-Chuan

2014-11-01

The report from the Institute of Medicine, To Err Is Human: Building a Safer Health System in 1999 drew a special attention towards preventable medical errors and patient safety. The American Reinvestment and Recovery Act of 2009 and federal criteria of 'Meaningful use' stage 1 mandated e-prescribing to be used by eligible providers in order to access Medicaid and Medicare incentive payments. Inappropriate prescribing has been identified as a preventable cause of at least 20% of drug-related adverse events. A few studies reported system-related errors and have offered targeted recommendations on improving and enhancing e-prescribing system. This study aims to enhance efficiency of the e-prescribing system by shortening the medication list, reducing the risk of inappropriate selection of medication, as well as in reducing the prescribing time of physicians. 103.48 million prescriptions from Taiwan's national health insurance claim data were used to compute Diagnosis-Medication association. Furthermore, 100,000 prescriptions were randomly selected to develop a smart medication recommendation model by using association rules of data mining. The important contribution of this model is to introduce a new concept called Mean Prescription Rank (MPR) of prescriptions and Coverage Rate (CR) of prescriptions. A proactive medication list (PML) was computed using MPR and CR. With this model the medication drop-down menu is significantly shortened, thereby reducing medication selection errors and prescription times. The physicians will still select relevant medications even in the case of inappropriate (unintentional) selection. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Social network analysis of duplicative prescriptions: One-month analysis of medical facilities in Japan.

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Takahashi, Yoshimitsu; Ishizaki, Tatsuro; Nakayama, Takeo; Kawachi, Ichiro

2016-03-01

Duplicative prescriptions refer to situations in which patients receive medications for the same condition from two or more sources. Health officials in Japan have expressed concern about medical "waste" resulting from this practices. We sought to conduct descriptive analysis of duplicative prescriptions using social network analysis and to report their prevalence across ages. We analyzed a health insurance claims database including 1.24 million people from December 2012. Through social network analysis, we examined the duplicative prescription networks, representing each medical facility as nodes, and individual prescriptions for patients as edges. The prevalence of duplicative prescription for any drug class was strongly correlated with its frequency of prescription (r=0.90). Among patients aged 0-19, cough and colds drugs showed the highest prevalence of duplicative prescriptions (10.8%). Among people aged 65 and over, antihypertensive drugs had the highest frequency of prescriptions, but the prevalence of duplicative prescriptions was low (0.2-0.3%). Social network analysis revealed clusters of facilities connected via duplicative prescriptions, e.g., psychotropic drugs showed clustering due to a few patients receiving drugs from 10 or more facilities. Overall, the prevalence of duplicative prescriptions was quite low - less than 10% - although the extent of the problem varied by drug class and age group. Our approach illustrates the potential utility of using a social network approach to understand these practices. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Prescriptions of Chinese Herbal Medicines for Insomnia in Taiwan during 2002

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Fang-Pey Chen

2011-01-01

Full Text Available Chinese herbal medicine (CHM has been commonly used for treating insomnia in Asian countries for centuries. The aim of this study was to conduct a large-scale pharmaco-epidemiologic study and evaluate the frequency and patterns of CHM use in treating insomnia. We obtained the traditional Chinese medicine (TCM outpatient claims from the National Health Insurance in Taiwan for the year 2002. Patients with insomnia were identified from the diagnostic code of International Classification of Disease among claimed visiting files. Corresponding prescription files were analyzed, and an association rule was applied to evaluate the co-prescription of CHM. Results showed that there were 16 134 subjects who visited TCM clinics for insomnia in Taiwan during 2002 and received a total of 29 801 CHM prescriptions. Subjects between 40 and 49 years of age comprised the largest number of those treated (25.3%. In addition, female subjects used CHMs for insomnia more frequently than male subjects (female : male = 1.94 : 1. There was an average of 4.8 items prescribed in the form of either an individual Chinese herb or formula in a single CHM prescription for insomnia. Shou-wu-teng (Polygonum multiflorum was the most commonly prescribed single Chinese herb, while Suan-zao-ren-tang was the most commonly prescribed Chinese herbal formula. According to the association rule, the most commonly prescribed CHM drug combination was Suan-zao-ren-tang plus Long-dan-xie-gan-tang, while the most commonly prescribed triple drug combination was Suan-zao-ren-tang, Albizia julibrissin, and P. multiflorum. Nevertheless, further clinical trials are needed to evaluate the efficacy and safety of these CHMs for treating insomnia.

Generic drug discount programs: are prescriptions being submitted for pharmacy benefit adjudication?

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Tungol, Alexandra; Starner, Catherine I; Gunderson, Brent W; Schafer, Jeremy A; Qiu, Yang; Gleason, Patrick P

2012-01-01

  In 2006, pharmacies began offering select generic prescription drugs at discount prices (e.g., $4 for a 30-day supply) through nonmembership and membership programs. As part of the contract in membership generic drug discount programs, the member agrees to forgo submission of the claim to the insurance company. Claims not submitted for insurance adjudication may result in incomplete pharmacy benefit manager (PBM) and health plan data, which could negatively influence adherence reporting and clinical programs. To address potentially missing claims data, the Centers for Medicare Medicaid Services (CMS) encourages Medicare Part D sponsors to incentivize network pharmacies to submit claims directly to the plan for drugs dispensed outside of a member's Part D benefit, unless a member refuses. The extent of PBM and health plan claims capture loss due to generic drug discount programs is unknown. To identify changes in levothyroxine utilizers' prescription claims capture rate following the advent of generic drug discount membership and nonmembership programs. This retrospective concurrent cohort study used claims data from 3.5 million commercially insured members enrolled in health plans located in the central and southern United States with Prime Therapeutics pharmacy benefit coverage. Members were required to be 18 years or older and younger than 60 years as of January 1, 2006, and continuously enrolled from January 1, 2006, through December 31, 2010. Members utilizing generic levothyroxine for at least 120 days during January 1, 2006, through June 30, 2006 (baseline period) from the same pharmacy group with supply on July 1, 2006, were placed into 1 of 3 pharmacy groups: (1) nonmembership (Walmart, Sam's Club, Target, Kroger, City Market, and King Soopers pharmacies), (2) membership (Walgreens, CVS, Albertsons, and Savon pharmacies), or (3) the reference group of all other pharmacies. The index date was defined as July 1, 2006. The levothyroxine claim providing

Retrospective evaluation of antimicrobial prescribing pattern in a ...

African Journals Online (AJOL)

Retrospective evaluation of antimicrobial prescribing pattern in a tertiary hospital in Nigeria. ... Annals of Biomedical Sciences ... prescription in University of Benin Teaching Hospital, Benin City, Nigeria over a period of seven years. Materials ...

What can we learn from patient claims? - A retrospective analysis of incidence and patterns of adverse events after orthopaedic procedures in Sweden

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Öhrn Annica

2012-01-01

Full Text Available Abstract Background Objective data on the incidence and pattern of adverse events after orthopaedic surgical procedures remain scarce, secondary to the reluctance for encompassing reporting of surgical complications. The aim of this study was to analyze the nature of adverse events after orthopaedic surgery reported to a national database for patient claims in Sweden. Methods In this retrospective review data from two Swedish national databases during a 4-year period were analyzed. We used the "County Councils' Mutual Insurance Company", a national no-fault insurance system for patient claims, and the "National Patient Register at the National Board of Health and Welfare". Results A total of 6,029 patient claims filed after orthopaedic surgery were assessed during the study period. Of those, 3,336 (55% were determined to be adverse events, which received financial compensation. Hospital-acquired infections and sepsis were the most common causes of adverse events (n = 741; 22%. The surgical procedure that caused the highest rate of adverse events was "decompression of spinal cord and nerve roots" (code ABC**, with 168 adverse events of 17,507 hospitals discharges (1%. One in five (36 of 168; 21.4% injured patient was seriously disabled or died. Conclusions We conclude that patients undergoing spinal surgery run the highest risk of being severely injured and that these patients also experienced a high degree of serious disability. The most common adverse event was related to hospital acquired infections. Claims data obtained in a no-fault system have a high potential for identifying adverse events and learning from them.

Prescriptions of Chinese herbal medicine for constipation under the national health insurance in Taiwan.

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Jong, Maw-Shiou; Hwang, Shinn-Jang; Chen, Yu-Chun; Chen, Tzeng-Ji; Chen, Fun-Jou; Chen, Fang-Pey

2010-07-01

Constipation is a common gastrointestinal problem worldwide. The aim of this study was to determine the frequency of use and prescriptive patterns of Chinese herbal medicine (CHM) in treating constipation by analyzing the claims data of traditional Chinese medicine (TCM) from the National Health Insurance (NHI) in Taiwan. The computerized claims dataset of the TCM office visits and the corresponding prescription files in 2004 compiled by the NHI Research Institute in Taiwan were linked and processed. Visit files with the single diagnostic coding of constipation (ICD-9-CM code 564.0) were extracted to analyze the frequency and pattern of corresponding CHM prescriptions. The association rule was applied to analyze the co-prescription of CHM in treating constipation. There were 152,564 subjects who visited TCM clinics only for constipation in Taiwan during 2004 and received a total of 387,268 CHM prescriptions. Subjects between 20 and 29 years of age comprised the largest number of those treated (25.5%). Female subjects used CHM for constipation more frequently than male subjects (female:male = 3.31:1). There was an average of 4.6 items of single Chinese herbs or formula in a single prescription for constipation. Ma-zi-renwan was the most commonly prescribed herbal formula, while Da-huang (Rheum palmatum) was the most commonly used single Chinese herb. According to the association rule, the most common prescribed pattern of 2-drug combination of CHM for treating constipation was Ban-xia-xie-xin-tang plus Ma-zi-ren-wan, while the 3-drug combination of CHM was Fang-feng-tong-sheng-san, Rheum palmatum and Ma-zi-ren-wan. This study showed the pattern of single Chinese herbs or herbal formulae used in treating constipation in Taiwan. Further clinical trials are needed to evaluate the efficacy and safety of these CHMs in treating constipation. 2010 Elsevier. Published by Elsevier B.V. All rights reserved.

Pharmacists correcting schedule II prescriptions: DEA flip-flops continue.

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Abood, Richard R

2010-12-01

The Drug Enforcement Administration (DEA) has in recent years engaged in flip-flopping over important policy decisions. The most recent example involved whether a pharmacist can correct a written schedule II prescription upon verification with the prescriber. For several years the DEA's policy permitted this practice. Then the DEA issued a conflicting policy statement in 2007 in the preamble to the multiple schedule II prescription regulation, causing a series of subsequent contradictory statements ending with the policy that pharmacists should follow state law or policy until the Agency issues a regulation. It is doubtful that the DEA's opinion in the preamble would in itself constitute legal authority, or that the Agency would try to enforce the opinion. Nonetheless, these flip-flop opinions have confused pharmacists, caused some pharmacies to have claims rejected by third party payors, and most likely have inconvenienced patients.

Compliance with the guidelines of prescription writing in a central hospital in the West Bank.

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Tayem, Y I; Ibrahim, M A; Qubaja, M M; Shraim, R K; Taha, O B; Abu Shkhedem, E

2013-09-01

This retrospective, cross-sectional study was carried out to evaluate the quality of 2208 outpatient prescriptions in a central hospital in the West Bank, Palestine. The physicians' handwriting was poorly readable or illegible in one-third of the prescriptions. The prescriber's name and signature and patient's name were mentioned in almost all orders whereas the patient's age was stated in 54.9%. The vast majority of physicians (95.5%) prescribed drugs using their trade (brand) names. Drug strength, quantity and dose/frequency were stated in 61.1%, 76% and 73.8% of prescriptions respectively. Only 33 prescriptions (1.5%) contained full directions for use for all drugs. Correlation analysis revealed that the presence of certain prescription elements was statistically significantly associated with the clinic of origin and the number of drugs prescribed. The overall poor legibility and incompleteness of the prescriptions is of concern.

A retrospective claims analysis of combination therapy in the treatment of adult attention-deficit/hyperactivity disorder (ADHD

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Pohl Gerhardt M

2009-06-01

Full Text Available Abstract Background Combination therapy in managing psychiatric disorders is not uncommon. While combination therapy has been documented for depression and schizophrenia, little is known about combination therapy practices in managing attention-deficit/hyperactivity disorder (ADHD. This study seeks to quantify the combination use of ADHD medications and to understand predictors of combination therapy. Methods Prescription dispensing events were drawn from a U.S. national claims database including over 80 managed-care plans. Patients studied were age 18 or over with at least 1 medical claim with a diagnosis of ADHD (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] code 314.0, a pharmacy claim for ADHD medication during the study period July2003 to June2004, and continuous enrollment 6 months prior to and throughout the study period. Dispensing events were grouped into 6 categories: atomoxetine (ATX, long-acting stimulants (LAS, intermediate-acting stimulants (IAS, short-acting stimulants (SAS, bupropion (BUP, and Alpha-2 Adrenergic Agonists (A2A. Events were assigned to calendar months, and months with combined use from multiple categories within patient were identified. Predictors of combination therapy for LAS and for ATX were modeled for patients covered by commercial plans using logistic regression in a generalized estimating equations framework to adjust for within-patient correlation between months of observation. Factors included age, gender, presence of the hyperactive component of ADHD, prior diagnoses for psychiatric disorders, claims history of recent psychiatric visit, insurance plan type, and geographic region. Results There were 18,609 patients identified representing a total of 11,886 months of therapy with ATX; 40,949 months with LAS; 13,622 months with IAS; 38,141 months with SAS; 22,087 months with BUP; and 1,916 months with A2A. Combination therapy was present in 19.7% of continuing

A retrospective claims analysis of combination therapy in the treatment of adult attention-deficit/hyperactivity disorder (ADHD).

Science.gov (United States)

Pohl, Gerhardt M; Van Brunt, David L; Ye, Wenyu; Stoops, William W; Johnston, Joseph A

2009-06-08

Combination therapy in managing psychiatric disorders is not uncommon. While combination therapy has been documented for depression and schizophrenia, little is known about combination therapy practices in managing attention-deficit/hyperactivity disorder (ADHD). This study seeks to quantify the combination use of ADHD medications and to understand predictors of combination therapy. Prescription dispensing events were drawn from a U.S. national claims database including over 80 managed-care plans. Patients studied were age 18 or over with at least 1 medical claim with a diagnosis of ADHD (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] code 314.0), a pharmacy claim for ADHD medication during the study period July 2003 to June 2004, and continuous enrollment 6 months prior to and throughout the study period. Dispensing events were grouped into 6 categories: atomoxetine (ATX), long-acting stimulants (LAS), intermediate-acting stimulants (IAS), short-acting stimulants (SAS), bupropion (BUP), and Alpha-2 Adrenergic Agonists (A2A). Events were assigned to calendar months, and months with combined use from multiple categories within patient were identified. Predictors of combination therapy for LAS and for ATX were modeled for patients covered by commercial plans using logistic regression in a generalized estimating equations framework to adjust for within-patient correlation between months of observation. Factors included age, gender, presence of the hyperactive component of ADHD, prior diagnoses for psychiatric disorders, claims history of recent psychiatric visit, insurance plan type, and geographic region. There were 18,609 patients identified representing a total of 11,886 months of therapy with ATX; 40,949 months with LAS; 13,622 months with IAS; 38,141 months with SAS; 22,087 months with BUP; and 1,916 months with A2A. Combination therapy was present in 19.7% of continuing months (months after the first month of therapy

Arts on prescription: a qualitative outcomes study.

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Stickley, T; Eades, M

2013-08-01

In recent years, participatory community-based arts activities have become a recognized and regarded method for promoting mental health. In the UK, Arts on Prescription services have emerged as a prominent form of such social prescribing. This follow-up study reports on the findings from interviews conducted with participants in an Arts on Prescription programme two years after previous interviews to assess levels of 'distance travelled'. This follow-up study used a qualitative interview method amongst participants of an Arts on Prescription programme of work. Ten qualitative one-to-one interviews were conducted in community-based arts venues. Each participant was currently using or had used mental health services, and had been interviewed two years earlier. Interviews were digitally recorded, transcribed and analysed. For each of the 10 participants, a lengthy attendance of Arts on Prescription had acted as a catalyst for positive change. Participants reported increased self-confidence, improved social and communication skills, and increased motivation and aspiration. An analysis of each of the claims made by participants enabled them to be grouped according to emerging themes: education: practical and aspirational achievements; broadened horizons: accessing new worlds; assuming and sustaining new identities; and social and relational perceptions. Both hard and soft outcomes were identifiable, but most were soft outcomes. Follow-up data indicating progress varied between respondents. Whilst hard outcomes could be identified in individual cases, the unifying factors across the sample were found predominately in the realm of soft outcomes. These soft outcomes, such as raised confidence and self-esteem, facilitated the hard outcomes such as educational achievement and voluntary work. Copyright © 2013 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Characterisation of antibiotic prescriptions for acute respiratory tract infections in Danish general practice: a retrospective registry based cohort study.

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Aabenhus, Rune; Hansen, Malene Plejdrup; Saust, Laura Trolle; Bjerrum, Lars

2017-05-19

Inappropriate use of antibiotics is contributing to the increasing rates of antimicrobial resistance. Several Danish guidelines on antibiotic prescribing for acute respiratory tract infections in general practice have been issued to promote rational prescribing of antibiotics, however it is unclear if these recommendations are followed. We aimed to characterise the pattern of antibiotic prescriptions for patients diagnosed with acute respiratory tract infections, by means of electronic prescriptions, labeled with clinical indications, from Danish general practice. Acute respiratory tract infections accounted for 456,532 antibiotic prescriptions issued between July 2012 and June 2013. Pneumonia was the most common indication with 178,354 prescriptions (39%), followed by acute tonsillitis (21%) and acute otitis media (19%). In total, penicillin V accounted for 58% of all prescriptions, followed by macrolides (18%) and amoxicillin (15%). The use of second-line agents increased with age for all indications, and comprised more than 40% of the prescriptions in patients aged >75 years. Women were more often prescribed antibiotics regardless of clinical indication. This is the first Danish study to characterise antibiotic prescription patterns for acute respiratory tract infections by data linkage of clinical indications. The findings confirm that penicillin V is the most commonly prescribed antibiotic agent for treatment of patients with an acute respiratory tract infection in Danish general practice. However, second-line agents like macrolides and amoxicillin with or without clavulanic acid are overused. Strategies to improve the quality of antibiotic prescribing especially for pneumonia, acute otitis media and acute rhinosinusitis are warranted. TRACKING THE OVERUSE OF ANTIBIOTICS: Better adherence to guidelines for prescribing antibiotics for different respiratory tract infections are warranted in Danish general practice. The over-use of antibiotics, particularly so

Prescription for antidepressant in reducing future alcohol-related readmission in patients suffering from depression and alcohol use disorder: a retrospective medical record review.

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Chan, Patrick; Yomen, Katie; Turcios, Jennifer; Richman, Mark

2015-12-21

Patients suffering from major depressive disorder are more likely to suffer from alcohol use disorder. The data is inconclusive for the effectiveness of antidepressant treatment of patients suffering from both illnesses in regards to improving sobriety and reducing alcohol-related healthcare expenses such as hospitalizations. The objective of this study is to determine if a new prescription of an antidepressant upon inpatient discharge is associated with a reduction in the number of future acute alcohol-related hospital readmissions to the same institution in patients suffering from major depressive disorder and alcohol-use disorder. A retrospective, medical record review study was conducted at a publicly-supported hospital in Sylmar, CA. A query was performed for adult patients admitted between 1/1/2005-12/31/2013 who had ICD-9 codes for both alcohol-use disorder and depression. Index admission was the first hospitalization in which the patient was currently consuming alcohol and had depression as identified by physician documentation as a problem. Acute alcohol-related admissions were those for alcohol intoxication or withdrawal (indicating current alcohol use). Patients were excluded if they were receiving an antidepressant on index admission, depressive disorder with a prescription for an antidepressant is not associated with a reduction in future readmissions, nor significantly increase the number of days to readmission. The study does not support the concept of antidepressants in reducing acute alcohol-related readmissions.

Study on drug costs associated with COPD prescription medicine in Denmark.

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Jakobsen, Marie; Anker, Niels; Dollerup, Jens; Poulsen, Peter Bo; Lange, Peter

2013-10-01

Spirometric studies of the general population estimate that 430 000 Danes have chronic obstructive pulmonary disease (COPD). COPD is mainly caused by smoking, and smoking cessation is the most important intervention to prevent disease progression. Cost-of-illness studies conclude that the costs associated with COPD in Denmark are significant, but costs of prescription medicine for COPD were not analysed. To analyse the societal costs associated with prescription medicine for COPD in Denmark. The study was designed as a nationwide retrospective register study of the drug costs (ATC group R03) associated with COPD in the period 2001-2010. Data were retrieved from the Prescription Database, the National Patient Register and the Centralised Civil Register. The population comprised individuals (40+ years) who had at least one prescription of selected R03 drugs and who had been either hospitalised with a COPD diagnosis or had at least one prescription for drugs primarily used for COPD. The study population comprised 166 462 individuals of which 97 916 were alive on 31 December 2010. The average annual drug costs (R03) were DKK 7842 (EUR 1055) per patient in 2010 with total costs of DKK 685 million (EUR 92 million). The average lifetime costs associated with COPD prescription medicine were estimated to be DKK 70 000-75 000 (EUR 9416-10 089) per patient (2010 prices). The costs associated with prescription medicine for COPD in Denmark are significant. © 2012 John Wiley & Sons Ltd.

Prescription Pattern Analysis of Nonsteroidal Anti-inflammatory Drugs in the Northeastern Iranian Population.

Science.gov (United States)

Zeinali, Majid; Tabeshpour, Jamshid; Maziar, Seyed Vahid; Taherzadeh, Zhila; Zirak, Mohammad Reza; Sent, Danielle; Azarkhiavi, Kamal Razavi; Eslami, Saeid

2017-01-01

Inappropriate nonsteroidal anti-inflammatory drugs (NSAIDs) therapy is a common cause of actual and potential adverse effects, such as bleeding and gastrointestinal ulceration, which exacerbates the patient's medical condition and might even be life threatening. We aimed to evaluate and analyze the prescription pattern of NSAIDs in Northeastern Iranian population and also provide suggestions for a more rational prescription behavior for such drugs. In this cross-sectional retrospective study, pattern of 1-year prescriptions was inspected based on 9.3 million prescriptions from two insurance companies. Type of NSAIDs, all dispensed doses and the number of NSAIDs ordered per prescription, and the route of administration for each patient were extracted from the databases. The prescription pattern of NSAIDs was analyzed seasonally. Out of 9,303,585 prescriptions, 19.3% contained at least one NSAID. Diclofenac was the most commonly prescribed NSAID (49.21%). At least two NSAIDs were simultaneously prescribed in 7% of prescriptions. General practitioners prescribed NSAIDs more frequently (67%) than specialists. Orthopedic surgeons and internists more frequently prescribed NSAIDs in comparison with other physicians (6% and 4%, respectively). Gastroprotective agents (GPAs) were coprescribed to only 7.62% of prescriptions. The frequency of NSAIDs prescription was relatively high in Northeast of Iran. A significant number of prescriptions were associated with irrational prescribing in both coadministration of NSAIDs and GPAs and NSAIDs combination. A strategy must be developed and implemented for prescribing and rational use of medications, e.g., continuing medical education regarding the potential risks of NSAIDs, importance of their appropriate and rational use, and necessity of appropriate prescription writing regarding both content and indication.

Emergency department visits by pediatric patients for poisoning by prescription opioids.

Science.gov (United States)

Tadros, Allison; Layman, Shelley M; Davis, Stephen M; Bozeman, Rachel; Davidov, Danielle M

2016-09-01

Prescription medication abuse is an increasingly recognized problem in the United States. As more opioids are being prescribed and abused by adults, there is an increased risk of both accidental and intentional exposure to children and adolescents. The impact of pediatric exposures to prescription pain pills has not been well studied. We sought to evaluate emergency department (ED) visits for poisoning by prescription opioids in pediatric patients. This retrospective study looked at clinical and demographic data from the Nationwide Emergency Department Sample (NEDS) from 2006 to 2012. There were 21,928 pediatric ED visits for prescription opioid poisonings and more than half were unintentional. There was a bimodal age distribution of patients, with slightly more than half occurring in females. The majority of patients were discharged from the ED. More visits in the younger age group (0-5 years) were unintentional, while the majority of visits in the adolescent age group (15-17 years) were intentional. Mean charge per discharge was $1,840 and $14,235 for admissions and surmounted to over $81 million in total charges. Poisonings by prescription opioids largely impact both young children and adolescents. These findings can be used to help target this population for future preventive efforts.

Prescription patterns for psychotropic drugs in cancer patients; a large population study in the Netherlands

NARCIS (Netherlands)

Guan, N.C.; Boks, M.P.; Smeets, H.M.; Zainal, N.Z.; Wit, N.J. de

2013-01-01

Background: Psychotropic drugs are commonly prescribed for various psychological complaints in cancer patients. We aim to examine the prescription pattern in cancer patients of three common psychotropic drugs: benzodiazepine, antidepressant and antipsychotic. Methods: This is a retrospective

Economic cost and epidemiological characteristics of patients with fibromyalgia claims.

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Robinson, Rebecca L; Birnbaum, Howard G; Morley, Melissa A; Sisitsky, Tamar; Greenberg, Paul E; Claxton, Ami J

2003-06-01

Fibromyalgia (FM) is characterized by widespread pain that can lead to significant patient disability, complex management decisions for physicians, and economic burden on society. We investigated the total costs of FM in an employer population. Administrative claims data of a Fortune 100 manufacturer were used to quantify direct (i.e., medical and pharmaceutical claims) and indirect (i.e., disability claims and imputed absenteeism) costs associated with FM. A total of 4699 patients with at least one FM claim between 1996 and 1998 were contrasted with a 10% random sample of the overall beneficiary population. Employee-only subsets of both samples also were drawn. Medical utilization, receipt of prescription drugs, and annual total costs were proportionately similar yet significantly greater among FM claimants than the overall sample (all p < 0.0001). Total annual costs for FM claimants were $5945 versus $2486 for the typical beneficiary (p < 0.0001). Six percent of these costs were attributable to FM-specific claims. The prevalence of disability was twice as high among FM employees than overall employees (p < 0.0001). For every dollar spent on FM-specific claims, the employer spent another $57 to $143 on additional direct and indirect costs. Hidden costs of disability and comorbidities greatly increase the true burden of FM. Regardless of the clinical understanding of FM, when a claim for FM is present, considerable costs are involved. Findings suggest that within the management of FM there may be large cost-offset opportunities for reductions in patient, physician, and employer burdens.

Assessment of linezolid prescriptions in three French hospitals.

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Dentan, C; Forestier, E; Roustit, M; Boisset, S; Chanoine, S; Epaulard, O; Pavese, P

2017-07-01

The use of linezolid to treat gram-positive cocci infections is increasing in France. Linezolid is approved in pneumonia and complicated skin and soft tissue infections. Overuse and misuse of linezolid can favor the emergence and spreading of linezolid-resistant strains. We aimed to assess the appropriateness of linezolid use in French hospitals. This is a multicenter, retrospective study conducted in three tertiary care hospitals. Appropriateness of linezolid indications and adequacy (composite score concerning dosage, route of administration and blood monitoring) were assessed. Over a three-month period, all prescriptions of linezolid were extracted and analyzed by two independent infectious disease experts. Among the 81 initial prescriptions that were evaluated, indication was appropriate in 48% of cases. Among those, 51% complied with international guidelines. Fifty-seven percent of the prescriptions were adequate regarding dosage, route of administration and blood monitoring. Overall, 23% of prescriptions combined both appropriateness and adequacy. The most frequent reasons for inappropriateness were the possibility of choosing narrower-spectrum antibiotics and the empirical use of linezolid in severe sepsis or septic shock. Initial treatment was the most frequently appropriate in bone and joint infection cases (p = 0.001). Our study shows that even if modalities of use were mostly correct, appropriateness of linezolid indications is low. Educational programs are mandatory to improve practices, as well as clinical studies to better assess the efficacy and safety of linezolid in clinical situations other than pneumonia or complicated skin and soft tissue infections.

Trends in prescription drug utilization and spending for the Department of Defense, 2002-2007.

Science.gov (United States)

Devine, Joshua W; Trice, Shana; Spridgen, Stacia L; Bacon, Thomas A

2009-09-01

Examine trends in U.S. Department of Defense (DoD) outpatient drug spending and utilization between 2002 and 2007. We analyzed pharmacy claims data from the U.S. Military Health System (MHS), using a cross-sectional analysis at the prescription and patient-year level and measuring utilization in 30-day equivalent prescriptions and expenditures in dollars. Pharmaceutical spending more than doubled in DoD, from $3 billion in FY02 to $6.5 billion in FY07. The largest increase occurred in the DoD community pharmacy network, where utilization grew from 6 million 30-day equivalent prescriptions in the first quarter of FY02 to more than 16 million in the last quarter of FY07. The smallest increase in annual spending occurred in FY07 (5.5%), down from a high of 27.5% in FY03. The MHS has experienced rapid growth in pharmaceutical spending since FY02. However, there are signs that growth in pharmaceutical spending may be slowing.

The prevalence and ingredient cost of chronic comorbidity in the Irish elderly population with medication treated type 2 diabetes: A retrospective cross-sectional study using a national pharmacy claims database

Directory of Open Access Journals (Sweden)

O’Shea Miriam

2013-01-01

Full Text Available Abstract Background Comorbidity in patients with diabetes is associated with poorer health and increased cost. The aim of this study was to investigate the prevalence and ingredient cost of comorbidity in patients ≥ 65 years with and without medication treated type 2 diabetes using a national pharmacy claims database. Methods The Irish Health Service Executive Primary Care Reimbursement Service pharmacy claims database, which includes all prescribing to individuals covered by the General Medical Services scheme, was used to identify the study population (≥ 65 years. Patients with medication treated type 2 diabetes (T2DM were identified using the prescription of oral anti-hyperglycaemic agents alone or in combination with insulin as a proxy for disease diagnosis. The prevalence and ingredient prescribing cost of treated chronic comorbidity in the study population with and without medication treated T2DM were ascertained using a modified version of the RxRiskV index, a prescription based comorbidity index. The association between T2DM and comorbid conditions was assessed using logistic regression adjusting for age and sex. Bootstrapping was used to ascertain the mean annual ingredient cost of treated comorbidity. Statistical significance at p  Results In 2010, 43165 of 445180 GMS eligible individuals (9.7% were identified as having received medication for T2DM. The median number of comorbid conditions was significantly higher in those with T2DM compared to without (median 5 vs. 3 respectively; p  Conclusions Individuals with T2DM were more likely to have a higher number of treated comorbid conditions than those without and this was associated with higher ingredient costs. This has important policy and economic consequences for the planning and provision of future health services in Ireland, given the expected increase in T2DM and other chronic conditions.

Status of medical liability claims in Saudi Arabia

International Nuclear Information System (INIS)

Samarkandi, A.

2006-01-01

With the evolution of health services in Saudi Arabia, there has been increase in the number of medical practice litigations. The author analyzed the medical malpractice litigation that was referred to the National Medico-Legal Committee (MLC) in order to evaluate the magnitude and underlying factors of the problem in Saudi Arabia. A retrospective analysis of the official records of Medico-Legal malpractice over the period 1420H-1424H (199-2003) was performed. The incidence among different medical specialties, location, and final resolution of each claim were identified. Data analysis revealed an increasing trend in the total number of claims over the study period, with a sharp increase in the transition between 1422H and 1423H (2001-200). The distribution of claims over different medical specialties showed that obstetrical practice took the lead with 27%, followed by general surgery and subspecialties, represented by 17% each, internal medicine 13%, while pediatrics contributed 10% of claims: the fewest claims were in dentistry with 2.5%. The majority of claims were referred to the Ministry of Health and private sectors medical facilities. Most claims were from the Riyadh region over the period between 1420H to 1422H (1999-2001), while thereafter, during 1423 and 1424H (2002 and 2003), the Holy Capital had the highest number of claims referred to the MLC. Adherence to standards of medical practice is by far the best approach to avoid or reduce the incidence of litigation. (author)

Chinese herbal prescriptions for osteoarthritis in Taiwan: analysis of national health insurance dataset

Science.gov (United States)

2014-01-01

Background Chinese herbal medicine (CHM) has been commonly used for treating osteoarthritis in Asia for centuries. This study aimed to conduct a large-scale pharmaco-epidemiologic study and evaluate the frequency and patterns of CHM used in treating osteoarthritis in Taiwan. Methods A complete database (total 22,520,776 beneficiaries) of traditional Chinese medicine (TCM) outpatient claims offered by the National Health Insurance program in Taiwan for the year 2002 was employed for this research. Patients with osteoarthritis were identified according to the diagnostic code of the International Classification of Disease among claimed visiting files. Corresponding prescription files were analyzed, and an association rule was applied to evaluate the co-prescription of CHM for treating osteoarthritis. Results There were 20,059 subjects who visited TCM clinics for osteoarthritis and received a total of 32,050 CHM prescriptions. Subjects between 40 and 49 years of age comprised the largest number of those treated (19.2%), followed by 50-59 years (18.8%) and 60-69 years group (18.2%). In addition, female subjects used CHMs for osteoarthritis more frequently than male subjects (female: male = 1.89: l). There was an average of 5.2 items prescribed in the form of either an individual Chinese herb or formula in a single CHM prescription for osteoarthritis. Du-zhong (Eucommia bark) was the most commonly prescribed Chinese single herb, while Du-huo-ji-sheng-tang was the most commonly prescribed Chinese herbal formula for osteoarthritis. According to the association rule, the most commonly prescribed formula was Du-huo-ji-sheng-tang plus Shen-tong-zhu-yu-tang, and the most commonly prescribed triple-drug combination was Du-huo-ji-sheng-tang, Gu-sui-pu (Drynaria fortune (Kunze) J. Sm.), and Xu-Duan (Himalaya teasel). Nevertheless, further clinical trials are needed to evaluate the efficacy and safety of these CHMs for treating osteoarthritis. Conclusions This study

The risk of malignancy among biologic-naïve pediatric psoriasis patients: A retrospective cohort study in a US claims database.

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Gu, Yun; Nordstrom, Beth L

2017-08-01

Little published literature exists regarding malignancy risk in pediatric psoriasis patients. To compare malignancy risk in biologic-naïve pediatric psoriasis patients with a matched pediatric population without psoriasis. This retrospective cohort study used IMS LifeLink Health Plan Claims data covering 1998-2008. Cancer incidence was compared with the US Surveillance, Epidemiology, and End Results (SEER) data using standardized incidence ratios (SIR), and between cohorts using Cox models. Among 9045 pediatric psoriasis patients and 77,206 comparators, 18 probable or highly probable cancers were identified. Pediatric psoriasis patients had a nonsignificantly lower incidence than comparators (hazard ratio [HR] 0.43, 95% confidence interval [CI] 0.05-3.54). The HR increased to 1.67 (95% CI 0.54-5.18) when cancer diagnosed during the first 90 days of follow-up was included. The pediatric psoriasis cohort had a significantly increased lymphoma rate compared with SEER (SIR 5.42, 95% CI 1.62-12.94), but no significant increase relative to the comparator cohort. Misclassification of disease and outcome might have occurred with patients in the claims database. Patients with pediatric psoriasis showed no significant increase in overall cancer risk compared with those without psoriasis. A potential increased risk for lymphoma was observed when compared with the general population. Copyright © 2017 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

Evaluation of the NCPDP Structured and Codified Sig Format for e-prescriptions.

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Liu, Hangsheng; Burkhart, Q; Bell, Douglas S

2011-01-01

To evaluate the ability of the structure and code sets specified in the National Council for Prescription Drug Programs Structured and Codified Sig Format to represent ambulatory electronic prescriptions. We parsed the Sig strings from a sample of 20,161 de-identified ambulatory e-prescriptions into variables representing the fields of the Structured and Codified Sig Format. A stratified random sample of these representations was then reviewed by a group of experts. For codified Sig fields, we attempted to map the actual words used by prescribers to the equivalent terms in the designated terminology. Proportion of prescriptions that the Format could fully represent; proportion of terms used that could be mapped to the designated terminology. The fields defined in the Format could fully represent 95% of Sigs (95% CI 93% to 97%), but ambiguities were identified, particularly in representing multiple-step instructions. The terms used by prescribers could be codified for only 60% of dose delivery methods, 84% of dose forms, 82% of vehicles, 95% of routes, 70% of sites, 33% of administration timings, and 93% of indications. The findings are based on a retrospective sample of ambulatory prescriptions derived mostly from primary care physicians. The fields defined in the Format could represent most of the patient instructions in a large prescription sample, but prior to its mandatory adoption, further work is needed to ensure that potential ambiguities are addressed and that a complete set of terms is available for the codified fields.

Substance use - prescription drugs

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Substance use disorder - prescription drugs; Substance abuse - prescription drugs; Drug abuse - prescription drugs; Drug use - prescription drugs; Narcotics - substance use; Opioid - substance use; Sedative - substance ...

Factors Associated With the Prophylactic Prescription of a Bowel Regimen to Prevent Opioid-Induced Constipation.

Science.gov (United States)

Chen, Nancy Y; Nguyen, Eugene; Schrager, Sheree M; Russell, Christopher J

2016-11-01

Identify factors associated with the prophylactic prescription of a bowel regimen with an inpatient opioid prescription. This was a retrospective cohort study from June 1, 2013, to October 31, 2014 of pediatric inpatients prescribed an oral or intravenous opioid on the general medical/surgical floors. We identified patients with or without a prophylactic prescription of a bowel regimen. We obtained patient demographics, prescriber training level and service and used multivariate logistic regression to analyze the factors associated with prophylactic bowel regimen and opioid prescription. Of the 6682 encounters that met study criteria, only 966 (14.5%) encounters had prophylactic prescriptions. Patient factors associated with prophylactic prescription include increasing age (per year; odds ratio [OR] = 1.06, 95% confidence interval [CI] 1.05-1.07) and sickle cell diagnosis (OR = 3.19, 95% CI 2.08-4.91). Medication factors associated with prophylactic prescription include a scheduled opioid prescription (OR = 1.75, 95% CI 1.46-2.1) and a prescription for oxycodone (OR = 3.59, 95% CI 2.57-5.00) or morphine (OR = 1.84, 95% CI 1.39-2.44), compared with acetaminophen-hydrocodone. Compared with medical providers, surgeons were less likely (OR = 0.43, 95% CI 0.35-0.53) and pain service providers were more likely to prescribe a prophylactic bowel regimen (OR = 4.12, 95% CI 3.13-5.43). More than 85% of inpatient opioid prescriptions did not receive a prophylactic bowel regimen. Future research should examine factors (eg, clinical decision support tools) to increase prophylactic prescription of bowel regimens with opioids for populations found to have lower rates. Copyright © 2016 by the American Academy of Pediatrics.

Characteristics of claims in the management of septic arthritis in Japan: Retrospective analyses of judicial precedents and closed claims

Directory of Open Access Journals (Sweden)

Yasuhiro Otaki

2018-03-01

Conclusion: It is important to pay particular attention to SA following sepsis in newborns and to monitor for any signs of SA after joint injection to ensure early diagnosis. Analysis of both malpractice claims and accident and incident reports is essential to ensure a full understanding of the situation in Japan.

Prescription of hazardous drugs during pregnancy.

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Malm, Heli; Martikainen, Jaana; Klaukka, Timo; Neuvonen, Pertti J

2004-01-01

Prescribing drugs to pregnant women requires the balancing of benefits and risks. Only a small proportion of drugs are known to be harmful to the fetus, but for the vast majority of drugs little evidence of fetal safety exists. To determine the prescription pattern of potentially and clearly harmful prescription drugs during pregnancy with reference to drug safety categorisation, and to define the drug groups primarily responsible for multiple drug use during pregnancy. A retrospective, register-based cohort study. Linkage of three nationwide registers in Finland. Data collection included prescription drugs purchased during the preconception period and each trimester in the pregnant cohort, and the corresponding time periods in the non-pregnant controls. The pregnancy safety categorisation was determined for each drug (Anatomic Therapeutic Chemical [ATC] code) by using the Swedish classification of approved medicinal products (Farmaceutiska Specialiteter i Sverige [FASS]) and if not available, the corresponding Australian (Australian Drug Evaluation Committee [ADEC]) or US categorisation (FDA). GROUPS STUDIED: Women applying for maternity support (maternal grants) during the year 1999 (n = 43 470) plus non-pregnant control women matched by age and hospital district (n = 43 470). In the pregnant cohort, 20.4% of women purchased at least one drug classified as potentially harmful during pregnancy, and 3.4% purchased at least one drug classified as clearly harmful. A significant decline occurred in the number of pregnant women purchasing potentially and clearly harmful drugs during the first trimester when compared with the preconception period, and the decline continued from the first to the second trimester. In the pregnant cohort, 107 (0.2%) women purchased at least ten different drugs during pregnancy. The drugs most commonly purchased in this group were topical corticosteroids and nasal preparations. The use of hazardous prescription drugs declines during

Frequency and co-prescription pattern of Chinese herbal products for hypertension in Taiwan: a Cohort study.

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Yang, Pei-Rung; Shih, Wei-Tai; Chu, Yen-Hua; Chen, Pau-Chung; Wu, Ching-Yuan

2015-06-06

Chinese herbal products (CHPs) have been frequently used among patients with chronic diseases including hypertension; however, the co-prescription pattern of herbal formulae and single herbs remain uncharacterized. Thus, this large-scale pharmacoepidemiological study evaluated the frequency and co-prescription pattern of CHPs for treating hypertension in Taiwan from 2003 to 2009. The database of traditional Chinese medicine (TCM) outpatient claims was obtained from the National Health Insurance in Taiwan. Patients with hypertension during study period were defined according to diagnostic codes in the International Classification of Disease Ninth Revision, Clinical Modification. The frequencies and percentages of herbal formula and single herb prescriptions for hypertension were analyzed. We also applied association rules to evaluate the CHPs co-prescription patterns. The hypertension cohort included 154,083 patients, 123,240 patients of which (approximately 80 %) had used TCM at least once. In total, 81,582 visits involving CHP prescriptions were hypertension related; Tian-Ma-Gou-Teng-Yin and Dan Shen (Radix Salvia Miltiorrhizae) were the most frequently prescribed herbal formula and single herb, respectively, for treating hypertension. This study elucidated the utilization pattern of CHPs for treating hypertension. Future studies on the efficacy and safety of these CHPs and on drug-herb interactions are warranted.

Association Between Employee Dental Claims, Health Risks, Workplace Productivity, and Preventive Services Compliance.

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Burton, Wayne N; Chen, Chin-Yu; Li, Xingquan; Schultz, Alyssa B

2017-08-01

This study examined differences in health risks and workplace outcomes among employees who utilized preventive dental services compared with other employees. A retrospective observational study of employees of a large financial services corporation, with data from health risk appraisal questionnaires, medical claims, pharmacy claims, and dental claims. Employees with no dental claims were significantly more likely to have a variety of health risk factors (such as obesity and tobacco use), health conditions (such as diabetes), absenteeism, and lost on-the-job productivity, and were significantly less likely to be compliant with clinical preventive services compared with those with preventive dental claims. Employees with preventive dental claims had fewer health risks and medical conditions and better health and productivity measures. Study employees underutilized free dental care; employers should incorporate preventive dental care awareness into their worksite wellness programs.

Prescription Drug Abuse

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... drug abuse. And it's illegal, just like taking street drugs. Why Do People Abuse Prescription Drugs? Some people abuse prescription drugs ... common risk of prescription drug abuse is addiction . People who abuse ... as if they were taking street drugs. That's one reason most doctors won't ...

Prescription patterns and costs of acne/rosacea medications in Medicare patients vary by prescriber specialty.

Science.gov (United States)

Zhang, Myron; Silverberg, Jonathan I; Kaffenberger, Benjamin H

2017-09-01

Prescription patterns for acne/rosacea medications have not been described in the Medicare population, and comparisons across specialties are lacking. To describe the medications used for treating acne/rosacea in the Medicare population and evaluate differences in costs between specialties. A cross-sectional study was performed of the 2008 and 2010 Centers for Medicare and Medicaid Services Prescription Drug Profiles, which contains 100% of Medicare part D claims. Topical antibiotics accounted for 63% of all prescriptions. Patients ≥65 years utilized more oral tetracycline-class antibiotics and less topical retinoids. Specialists prescribed brand name drugs for the most common topical retinoids and most common topical antibiotics more frequently than family medicine/internal medicine (FM/IM) physicians by 6%-7%. Topical retinoids prescribed by specialists were, on average, $18-$20 more in total cost and $2-$3 more in patient cost than the same types of prescriptions from FM/IM physicians per 30-day supply. Specialists (60%) and IM physicians (56%) prescribed over twice the rate of branded doxycycline than FM doctors did (27%). The total and patient costs for tetracycline-class antibiotics were higher from specialists ($18 and $4 more, respectively) and IM physicians ($3 and $1 more, respectively) than they were from FM physicians. The data might contain rare prescriptions used for conditions other than acne/rosacea, and suppression algorithms might underestimate the number of specialist brand name prescriptions. Costs of prescriptions for acne/rosacea from specialists are higher than those from primary care physicians and could be reduced by choosing generic and less expensive options. Copyright © 2017 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

Antihypertensive drug prescription patterns and their impact on outcome of blood pressure in Ethiopia: a hospital-based cross-sectional study.

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Abegaz, Tadesse Melaku; Tefera, Yonas Getaye; Abebe, Tamrat Befekadu

2017-01-01

Irrational prescription is strongly associated with poor control of hypertension. The present study aimed to evaluate antihypertensive drug prescription trends and to measure their impact on the level of blood pressure (BP) control in Gondar University Hospital, Gondar, Ethiopia. A hospital-based retrospective cross-sectional study was conducted from May 30 to June 30, 2016. All hypertensive patients on medication were included. A structured data abstraction form was prepared to gather the necessary information. The prescription patterns and BP level were measured retrospectively. A binary logistic regression was computed to determine the effect of different prescription patterns on BP control. A total of 596 hypertension patients were recruited for the study; of them, 561(94%) met the study criteria. The mean age of the respondents was 55.96±14.6 years. Females constituted 58.2% of the study population. Approximately fifty percent of the prescriptions were monotherapies. Twice-daily dosing was associated with lower risk of uncontrolled hypertension (crude odds ratio [COR] =0.51[0.15-0.73], adjusted odds ratio [AOR] =0.69[0.163-0.91]). Monthly appointment was linked with a nearly 90% reduced incidence of uncontrolled BP (COR =0.15[0.04-0.73], AOR =0.093[0.024-0.359]). Monotherapies were the most frequently prescribed regimens. Twice-daily dosing and monthly appointments were associated with low incidence of uncontrolled BP. Clinicians should be vigilant in adjusting the frequency of dosing and should fix appointment date in consultation with their patients.

Creating Demand for Prescription Drugs: A Content Analysis of Television Direct-to-Consumer Advertising

Science.gov (United States)

Frosch, Dominick L.; Krueger, Patrick M.; Hornik, Robert C.; Cronholm, Peter F.; Barg, Frances K.

2007-01-01

PURPOSE American television viewers see as many as 16 hours of prescription drug advertisements (ads) each year, yet no research has examined how television ads attempt to influence consumers. This information is important, because ads may not meet their educational potential, possibly prompting consumers to request prescriptions that are clinically inappropriate or more expensive than equally effective alternatives. METHODS We coded ads shown during evening news and prime time hours for factual claims they make about the target condition, how they attempt to appeal to consumers, and how they portray the medication and lifestyle behaviors in the lives of ad characters. RESULTS Most ads (82%) made some factual claims and made rational arguments (86%) for product use, but few described condition causes (26%), risk factors (26%), or prevalence (25%). Emotional appeals were almost universal (95%). No ads mentioned lifestyle change as an alternative to products, though some (19%) portrayed it as an adjunct to medication. Some ads (18%) portrayed lifestyle changes as insufficient for controlling a condition. The ads often framed medication use in terms of losing (58%) and regaining control (85%) over some aspect of life and as engendering social approval (78%). Products were frequently (58%) portrayed as a medical breakthrough. CONCLUSIONS Despite claims that ads serve an educational purpose, they provide limited information about the causes of a disease or who may be at risk; they show characters that have lost control over their social, emotional, or physical lives without the medication; and they minimize the value of health promotion through lifestyle changes. The ads have limited educational value and may oversell the benefits of drugs in ways that might conflict with promoting population health. PMID:17261859

Creating demand for prescription drugs: a content analysis of television direct-to-consumer advertising.

Science.gov (United States)

Frosch, Dominick L; Krueger, Patrick M; Hornik, Robert C; Cronholm, Peter F; Barg, Frances K

2007-01-01

American television viewers see as many as 16 hours of prescription drug advertisements (ads) each year, yet no research has examined how television ads attempt to influence consumers. This information is important, because ads may not meet their educational potential, possibly prompting consumers to request prescriptions that are clinically inappropriate or more expensive than equally effective alternatives. We coded ads shown during evening news and prime time hours for factual claims they make about the target condition, how they attempt to appeal to consumers, and how they portray the medication and lifestyle behaviors in the lives of ad characters. Most ads (82%) made some factual claims and made rational arguments (86%) for product use, but few described condition causes (26%), risk factors (26%), or prevalence (25%). Emotional appeals were almost universal (95%). No ads mentioned lifestyle change as an alternative to products, though some (19%) portrayed it as an adjunct to medication. Some ads (18%) portrayed lifestyle changes as insufficient for controlling a condition. The ads often framed medication use in terms of losing (58%) and regaining control (85%) over some aspect of life and as engendering social approval (78%). Products were frequently (58%) portrayed as a medical breakthrough. Despite claims that ads serve an educational purpose, they provide limited information about the causes of a disease or who may be at risk; they show characters that have lost control over their social, emotional, or physical lives without the medication; and they minimize the value of health promotion through lifestyle changes. The ads have limited educational value and may oversell the benefits of drugs in ways that might conflict with promoting population health.

Overdosed paracetamol (acetaminophen) prescriptions and subsequent pharmacist interventions in French hospitals.

Science.gov (United States)

Charpiat, B; Bedouch, P; Rose, F X; Juste, M; Roubille, R; Conort, O; Allenet, B

2013-11-01

Little is known about the manner in which hospital pharmacists intervene for overdosed paracetamol prescriptions. The aim of this retrospective study was to describe the number and nature of pharmacists' interventions (PIs) for overdosed paracetamol adult prescriptions in hospitals. We studied PIs that had been documented by pharmacists on the French Society of Clinical Pharmacy website tool between 2007 and 2010. We identified PIs that were related to paracetamol-containing prescriptions of one brand name only (type 1) particularly for patients with body weight ≤ 50 kg who were prescribed 4 g/day, and PIs that concerned the co-prescription of two paracetamol-containing products (type 2). Among 60 hospitals, seven did not report any paracetamol overdose-related PIs. Of the 53 hospitals that had at least one PI, 16 did not report any type 1 PIs. Bodyweight, liver disease, cirrhosis and chronic alcoholism were absent recorded criterion by most of the hospitals included in this study. Previously published studies have highlighted that the most frequent PIs are type 1, especially for patients whose body weight is ≤ 50 kg. We observed a broad variability in the number or type of PI that were related to overdosed paracetamol prescriptions compared with the total of all recorded types of PI. These data suggest that a significant number of hospital pharmacists are unaware of the risks that adult patients with low body weight are exposed to when receiving four grams paracetamol/day over several days. Pharmacist educational programs are needed. Copyright © 2013. Published by Elsevier Masson SAS.

FDA direct-to-consumer advertising for prescription drugs: what are consumer preferences and response tendencies?

Science.gov (United States)

Khanfar, Nile; Loudon, David; Sircar-Ramsewak, Feroza

2007-01-01

The effect of direct-to-consumer (DTC) television advertising of prescription medications is a growing concern of the United States (U.S.) Congress, state legislatures, and the Food and Drug Administration (FDA). This research study was conducted in order to examine consumers' perceived preferences of DTC television advertisement in relation to "reminder" "help-seeking," and "product-claim" FDA-approved advertisement categories. An additional objective was to examine the influence of DTC television advertising of prescription drugs on consumers' tendency to seek more information about the medication and/or the medical condition. The research indicates that DTC television drug ads appear to be insufficient for consumers to make informed decisions. Their mixed perception and acceptance of the advertisements seem to influence them to seek more information from a variety of medical sources.

Accuracy of claims-based algorithms for epilepsy research: Revealing the unseen performance of claims-based studies.

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Moura, Lidia M V R; Price, Maggie; Cole, Andrew J; Hoch, Daniel B; Hsu, John

2017-04-01

To evaluate published algorithms for the identification of epilepsy cases in medical claims data using a unique linked dataset with both clinical and claims data. Using data from a large, regional health delivery system, we identified all patients contributing biologic samples to the health system's Biobank (n = 36K). We identified all subjects with at least one diagnosis potentially consistent with epilepsy, for example, epilepsy, convulsions, syncope, or collapse, between 2014 and 2015, or who were seen at the epilepsy clinic (n = 1,217), plus a random sample of subjects with neither claims nor clinic visits (n = 435); we then performed a medical chart review in a random subsample of 1,377 to assess the epilepsy diagnosis status. Using the chart review as the reference standard, we evaluated the test characteristics of six published algorithms. The best-performing algorithm used diagnostic and prescription drug data (sensitivity = 70%, 95% confidence interval [CI] 66-73%; specificity = 77%, 95% CI 73-81%; and area under the curve [AUC] = 0.73, 95%CI 0.71-0.76) when applied to patients age 18 years or older. Restricting the sample to adults aged 18-64 years resulted in a mild improvement in accuracy (AUC = 0.75,95%CI 0.73-0.78). Adding information about current antiepileptic drug use to the algorithm increased test performance (AUC = 0.78, 95%CI 0.76-0.80). Other algorithms varied in their included data types and performed worse. Current approaches for identifying patients with epilepsy in insurance claims have important limitations when applied to the general population. Approaches incorporating a range of information, for example, diagnoses, treatments, and site of care/specialty of physician, improve the performance of identification and could be useful in epilepsy studies using large datasets. Wiley Periodicals, Inc. © 2017 International League Against Epilepsy.

Availability of prescription drugs for bipolar disorder at online pharmacies.

Science.gov (United States)

Monteith, Scott; Glenn, Tasha; Bauer, Rita; Conell, Jörn; Bauer, Michael

2016-03-15

There is increasing use of online pharmacies to purchase prescription drugs. While some online pharmacies are legitimate and safe, there are many unsafe and illegal so-called "rogue" online pharmacies. This study investigated the availability of psychotropic drugs online to consumers in the US, using 5 commonly prescribed drugs for bipolar disorder. Using the search term "buy [drug name]" in the Google, Yahoo and Bing search engines, the characteristics of the online pharmacies found on the first two pages of search results were investigated. The availability of the requested dosage and formulations of two brand (Seroquel XR, Abilify) and three generic drugs (lamotrigine, lithium carbonate and bupropion SR) were determined. Of 30 online pharmacies found, 17 (57%) were rated as rogue by LegitScript. Of the 30 pharmacies, 15 (50%) require a prescription, 21 (70%) claim to be from Canada, with 20 of these having a Canadian International Pharmacy association (CIPA) seal on the website. Only 13 of the 20 sites with a CIPA seal were active CIPA members. There were about the same number of trust verification seals on the rogue and legitimate pharmacy sites. Some rogue pharmacies are professional in appearance, and may be difficult for consumers to recognize as rogue. All five brand and generic drugs were offered for sale online, with or without a prescription. However, many substitutions were presented such as different strengths and formulations including products not approved by the FDA. No evaluation of product quality, packaging or purchasing. Psychotropic medications are available online with or without a prescription. The majority of online pharmacy websites were rogue. Physicians should ask about the use of online pharmacies. For those who choose to use online pharmacies, two measures to detect rogue pharmacies are recommended: (1) only purchase drugs from pharmacies that require a prescription, and (2) check all pharmacy verification seals directly on the website

Partnership for Prescription Assistance

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... may use our name without our permission. The Partnership for Prescription Assistance will help you find the ... Events Blog Facebook Twitter Start living better. The Partnership for Prescription Assistance helps qualifying patients without prescription ...

This Article Makes You Smarter! (Or, Regulating Health and Wellness Claims).

Science.gov (United States)

Duranske, Sarah

2017-03-01

Information has power - to inspire, to transform, and to harm. Recent technological advancements have enabled the creation of products that offer consumers direct access to a level of personal health information unprecedented in history. But how are we to balance the promise of health and wellness information with its risks? Two agencies are tasked with protecting consumers from false claims of health products: the FDA and the FTC. This Article investigates if they are up to the task. In part a study of agency policymaking choices, and in part a prescription for more thoughtful and focused regulation, this Article compares both intra-agency and inter-agency regulation of informational health and wellness products. Certain procedural and substantive characteristics of FDA regulation are unsuited to informational health and wellness products, rendering comprehensive regulation by the FDA unrealistic. This gap creates an opportunity for the FTC to use its distinct and well-tailored enforcement tools to police harmful product claims that escape the FDA's purview. I posit that by tailoring the FDA's responsibility and sustaining the FTC's engagement with health claims, the agencies can dovetail into a cohesive and comprehensive regulatory regime.

The Association of Industry Payments to Physicians with Prescription of Brand-Name Intranasal Corticosteroids.

Science.gov (United States)

Morse, Elliot; Fujiwara, Rance J T; Mehra, Saral

2018-06-01

Objectives To examine the association of industry payments for brand-name intranasal corticosteroids with prescribing patterns. Study Design Cross-sectional retrospective analysis. Setting Nationwide. Subjects and Methods We identified physicians prescribing intranasal corticosteroids to Medicare beneficiaries 2014-2015 and physicians receiving payment for the brand-name intranasal corticosteroids Dymista and Nasonex. Prescription and payment data were linked by physician, and we compared the proportion of prescriptions written for brand-name intranasal corticosteroids in industry-compensated vs non-industry-compensated physicians. We associated the number and dollar amount of industry payments with the relative frequency of brand-name prescriptions. Results In total, 164,587 physicians prescribing intranasal corticosteroids were identified, including 7937 (5%) otolaryngologists; 10,800 and 3886 physicians received industry compensation for Dymista and Nasonex, respectively. Physicians receiving industry payment for Dymista prescribed more Dymista as a proportion of total intranasal corticosteroid prescriptions than noncompensated physicians (3.1% [SD = 9.6%] vs 0.2% [SD = 2.5%], respectively, P association was stronger in otolaryngologists than general practitioners ( P brand-name intranasal corticosteroids is significantly associated with prescribing patterns. The magnitude of association may depend on physician specialty and the drug's time on the market.

[Prescription annotations in Welfare Pharmacy].

Science.gov (United States)

Han, Yi

2018-03-01

Welfare Pharmacy contains medical formulas documented by the government and official prescriptions used by the official pharmacy in the pharmaceutical process. In the last years of Southern Song Dynasty, anonyms gave a lot of prescription annotations, made textual researches for the name, source, composition and origin of the prescriptions, and supplemented important historical data of medical cases and researched historical facts. The annotations of Welfare Pharmacy gathered the essence of medical theory, and can be used as precious materials to correctly understand the syndrome differentiation, compatibility regularity and clinical application of prescriptions. This article deeply investigated the style and form of the prescription annotations in Welfare Pharmacy, the name of prescriptions and the evolution of terminology, the major functions of the prescriptions, processing methods, instructions for taking medicine and taboos of prescriptions, the medical cases and clinical efficacy of prescriptions, the backgrounds, sources, composition and cultural meanings of prescriptions, proposed that the prescription annotations played an active role in the textual dissemination, patent medicine production and clinical diagnosis and treatment of Welfare Pharmacy. This not only helps understand the changes in the names and terms of traditional Chinese medicines in Welfare Pharmacy, but also provides the basis for understanding the knowledge sources, compatibility regularity, important drug innovations and clinical medications of prescriptions in Welfare Pharmacy. Copyright© by the Chinese Pharmaceutical Association.

Drug plan design incentives among Medicare prescription drug plans.

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Huskamp, Haiden A; Keating, Nancy L; Dalton, Jesse B; Chernew, Michael E; Newhouse, Joseph P

2014-07-01

Medicare Advantage prescription drug plans (MA-PDs) and standalone prescription drug plans (PDPs) face different incentives for plan design resulting from the scope of covered benefits (only outpatient drugs for PDPs versus all drug and nondrug services for Medicare Advantage [MA]/MA-PDs). The objective is to begin to explore how MA-PDs and PDPs may be responding to their different incentives related to benefit design. We compared 2012 PDP and MA-PD average formulary coverage, prior authorization (PA) or step therapy use, and copayment requirements for drugs in 6 classes used commonly among Medicare beneficiaries. We primarily used 2012 Prescription Drug Plan Formulary and Pharmacy Network Files and MA enrollment data. 2011 Truven Health MarketScan claims were used to estimate drug prices and to compute drug market share. Average coverage and PA/step rates, and average copayment requirements, were weighted by plan enrollment and drug market share. MA-PDs are generally more likely to cover and less likely to require PA/step for brand name drugs with generic alternatives than PDPs, and MA-PDs often have lower copayment requirements for these drugs. For brands without generics, we generally found no differences in average rates of coverage or PA/step, but MA-PDs were more likely to cover all brands without generics in a class. We found modest, confirmatory evidence suggesting that PDPs and MA-PDs respond to different incentives for plan design. Future research is needed to understand the factors that influence Medicare drug plan design decisions.

A Comparison of Self-reported Medication Adherence to Concordance Between Part D Claims and Medication Possession.

Science.gov (United States)

Savitz, Samuel T; Stearns, Sally C; Zhou, Lei; Thudium, Emily; Alburikan, Khalid A; Tran, Richard; Rodgers, Jo E

2017-05-01

Medicare Part D claims indicate medication purchased, but people who are not fully adherent may extend prescription use beyond the interval prescribed. This study assessed concordance between Part D claims and medication possession at a study visit in relation to self-reported medication adherence. We matched Part D claims for 6 common medications to medications brought to a study visit in 2011-2013 for the Atherosclerosis Risk in Communities study. The combined data consisted of 3027 medication events (claims, medications possessed, or both) for 2099 Atherosclerosis Risk in Communities study participants. Multinomial logistic regression estimated the association of concordance (visit only, Part D only, or both) with self-reported medication adherence while controlling for sociodemographic characteristics, veteran status, and availability under Generic Drug Discount Programs. Relative to participants with high adherence, medication events for participants with low adherence were approximately 25 percentage points less likely to match and more likely to be visit only (PDiscount Programs were 3 percentage points more likely to be visit only. Part D claims were substantially less likely to be concordant with medications possessed at study visit for participants with low self-reported adherence. This result supports the construction of adherence proxies such as proportion days covered using Part D claims.

Exercise Dosing and Prescription-Playing It Safe: Dangers and Prescription.

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Wang, Lei; Ai, Dongmei; Zhang, Ning

2017-01-01

Cardiac rehabilitation is a comprehensive and multidisciplinary program, and exercise training is extremely crucial in the whole program. In the past decades, many researches have shown the beneficial effects of exercise for cardiovascular disease (CVD) is indisputable Nevertheless, only a well-designed exercise prescription may achieve the ideal benefits. In this chapter, we will have a discussion of what is exercise prescription and how to establish a scientific and appropriate exercise prescription for CVD patients depending on the current scientific evidence and recommendations.

Non-steroidal anti-inflammatory drugs and antibiotics prescription trends at a central west bank hospital.

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Tayem, Yasin I; Qubaja, Marwan M; Shraim, Riyad K; Taha, Omar B; Abu Shkheidem, Imadeddin A; Ibrahim, Murad A

2013-11-01

We aimed to reliably describe the pattern of outpatient prescription of non-steroidal anti-inflammatory drugs (NSAIDs) and antibiotics (ATBs) at a central hospital in the West Bank, Palestine. This was a retrospective, cross-sectional study investigating a cohort of 2,208 prescriptions ordered by outpatient clinics and the emergency room over one year in Beit Jala Hospital in Bethlehem, West Bank. The orders were analysed for the rate and types of NSAIDs and ATBs utilised, and the appropriateness of these drugs to the diagnosis. Of the total prescriptions, 410 contained NSAIDs (18.6%), including diclofenac (40.2%), low dose aspirin (23.9%), ibuprofen (17.8%) and indomethacin (15.1%). A minority of these prescriptions contained a combination of these agents (2.5%). Only one prescription contained cyclooxyeganse-2 inhibitors (0.2%). The appropriateness of NSAID use to the diagnosis was as follows: appropriate (58.3%), inappropriate (14.4%) and difficult to tell (27.3%). The rate of ATB use was 30.3% (669 prescriptions). The ATBs prescribed were amoxicillin (23.3%), augmentin (14.3%), quinolones (12.7%), first and second generation cephalosporins (9.4% and 12.7%, respectively) and macrolides (7.2%). ATB combinations were identified in 9.4%, with the most common being second-generation cephalopsorins and metronidazole (4.3%). Regarding the appropriateness of prescribing ATBs according to the diagnosis, it was appropriate in 44.8%, inappropriate in 20.6% and difficult to tell in 34.6% of the prescriptions. These findings revealed a relatively large number and inappropriate utilisation of ATBs and NSAIDs. An interventional programme needs to be adopted to reinforce physicians' knowledge of the rational prescription of these agents.

Prevalence of possible drug-drug interactions between antiretroviral agents in different age groups in a section of the private health care sector setting in South Africa.

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Katende-Kyenda, N L; Lubbe, M S; Serfontein, J H P; Truter, I

2008-08-01

The chronic nature of human immunodeficiency virus (HIV) infection requires lifelong highly active antiretroviral (ARV) therapy (HAART) to continuously suppress HIV-1 viral replication, thus reducing morbidity and mortality. HAART is restricted by complex dosing, drug-drug interactions (DDIs) and toxicities. To determine the prevalence of possible DDIs between ARV drugs in different age groups in a section of the private primary health care sector in South Africa. A quantitative, retrospective drug utilization review was performed on 47 085 ARV prescriptions claimed through a national medicine claims database during 2006. Possible DDIs identified were classified according to a clinical significance rating as described by Tatro [Drug Interaction Facts 2005. St Louis, MO: Facts and Comparisons (2005)]. The total number of patients who received prescriptions that were claimed through the medicine claims database was 275 424, of whom 25.11% were males, 28.28% were females and the gender of 46.61% patients was unknown. Of the total number of patients, 3.27% were HIV patients of which an average of 5.23 +/- 3.86 ARV prescriptions (n = 47 085) per patient were claimed for representing 4.73% of the total number of prescriptions claimed during the study period (N = 993 804). HIV patients received an average of 2.36 +/- 0.61 ARVs per prescription. Only 4.95% of the prescriptions had one ARV medicine item, 56.04% two, 37.10% three, 1.75% four and 6 years and 12 and 60 years with patients <40 years and < or =60 years having the highest number of DDIs and patients older than 60 years the lowest. The majority of DDIs between the ARVs presented in significance levels 2 and 4. The most important interactions were between: indinavir (IDV) and ritonavir (n = 199); efavirenz (EFV) and lopinavir/ritonavir (n = 65) and EFV and IDV (n = 60) all interacting at level 2. The importance of using drug utilization study as an identification tool to provide insight into the prescribing and

32 CFR 536.120 - Claims payable as maritime claims.

Science.gov (United States)

2010-07-01

... 32 National Defense 3 2010-07-01 2010-07-01 true Claims payable as maritime claims. 536.120... ACCOUNTS CLAIMS AGAINST THE UNITED STATES Maritime Claims § 536.120 Claims payable as maritime claims. A claim is cognizable under this subpart if it arises in or on a maritime location, involves some...

The prevalence and incidence of medicinal cannabis on prescription in The Netherlands.

Science.gov (United States)

Hazekamp, Arno; Heerdink, Eibert R

2013-08-01

A growing number of countries are providing pharmaceutical grade cannabis to chronically ill patients. However, little published data is known about the extent of medicinal cannabis use and the characteristics of patients using cannabis on doctor's prescription. This study describes a retrospective database study of The Netherlands. Complete dispensing histories were obtained of all patients with at least one medicinal cannabis prescription gathered at pharmacies in The Netherlands in the period 2003-2010. Data revealed prevalence and incidence of use of prescription cannabis as well as characteristics of patients using different cannabis varieties. Five thousand five hundred forty patients were identified. After an initial incidence of about 6/100,000 inhabitants/year in 2003 and 2004, the incidence remained stable at 3/100,000/year in 2005-2010. The prevalence rate ranged from 5 to 8 per 100,000 inhabitants. Virtually all patients used some form of prescription medication in the 6 months preceding start of cannabis use, most particularly psycholeptics (45.5 %), analgesics (44.3 %), anti-ulcer agents (35.9 %) and NSAIDs (30.7 %). We found no significant association between use of medication of common indications for cannabis (pain, HIV/AIDS, cancer, nausea, glaucoma) and variety of cannabis used. This is the first nationwide study into the extent of prescription of medicinal cannabis. Although the cannabis varieties studied are believed to possess different therapeutic effects based on their different content of tetrahydrocannabinol (THC) and cannabidiol (CBD), no differences in choice of variety was found associated with indication.

Primary care closed claims experience of Massachusetts malpractice insurers.

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Schiff, Gordon D; Puopolo, Ann Louise; Huben-Kearney, Anne; Yu, Winnie; Keohane, Carol; McDonough, Peggy; Ellis, Bonnie R; Bates, David W; Biondolillo, Madeleine

Despite prior focus on high-impact inpatient cases, there are increasing data and awareness that malpractice in the outpatient setting, particularly in primary care, is a leading contributor to malpractice risk and claims. To study patterns of primary care malpractice types, causes, and outcomes as part of a Massachusetts ambulatory malpractice risk and safety improvement project. Retrospective review of pooled closed claims data of 2 malpractice carriers covering most Massachusetts physicians during a 5-year period (January 1, 2005, through December 31, 2009). Data were harmonized between the 2 insurers using a standardized taxonomy. Primary care practices in Massachusetts. All malpractice claims that involved primary care practices insured by the 2 largest insurers in the state were screened. A total of 551 claims from primary care practices were identified for the analysis. Numbers and types of claims, including whether claims involved primary care physicians or practices; classification of alleged malpractice (eg, misdiagnosis or medication error); patient diagnosis; breakdown in care process; and claim outcome (dismissed, settled, verdict for plaintiff, or verdict for defendant). During a 5-year period there were 7224 malpractice claims of which 551 (7.7%) were from primary care practices. Allegations were related to diagnosis in 397 (72.1%), medications in 68 (12.3%), other medical treatment in 41 (7.4%), communication in 15 (2.7%), patient rights in 11 (2.0%), and patient safety or security in 8 (1.5%). Leading diagnoses were cancer (n = 190), heart diseases (n = 43), blood vessel diseases (n = 27), infections (n = 22), and stroke (n = 16). Primary care cases were significantly more likely to be settled (35.2% vs 20.5%) or result in a verdict for the plaintiff (1.6% vs 0.9%) compared with non-general medical malpractice claims (P < .001). In Massachusetts, most primary care claims filed are related to alleged misdiagnosis. Compared with malpractice

Errors and omissions in hospital prescriptions: a survey of prescription writing in a hospital.

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Calligaris, Laura; Panzera, Angela; Arnoldo, Luca; Londero, Carla; Quattrin, Rosanna; Troncon, Maria G; Brusaferro, Silvio

2009-05-13

The frequency of drug prescription errors is high. Excluding errors in decision making, the remaining are mainly due to order ambiguity, non standard nomenclature and writing illegibility. The aim of this study is to analyse, as a part of a continuous quality improvement program, the quality of prescriptions writing for antibiotics, in an Italian University Hospital as a risk factor for prescription errors. The point prevalence survey, carried out in May 26-30 2008, involved 41 inpatient Units. Every parenteral or oral antibiotic prescription was analysed for legibility (generic or brand drug name, dose, frequency of administration) and completeness (generic or brand name, dose, frequency of administration, route of administration, date of prescription and signature of the prescriber). Eight doctors (residents in Hygiene and Preventive Medicine) and two pharmacists performed the survey by reviewing the clinical records of medical, surgical or intensive care section inpatients. The antibiotics drug category was chosen because its use is widespread in the setting considered. Out of 756 inpatients included in the study, 408 antibiotic prescriptions were found in 298 patients (mean prescriptions per patient 1.4; SD +/- 0.6). Overall 92.7% (38/41) of the Units had at least one patient with antibiotic prescription. Legibility was in compliance with 78.9% of generic or brand names, 69.4% of doses, 80.1% of frequency of administration, whereas completeness was fulfilled for 95.6% of generic or brand names, 76.7% of doses, 83.6% of frequency of administration, 87% of routes of administration, 43.9% of dates of prescription and 33.3% of physician's signature. Overall 23.9% of prescriptions were illegible and 29.9% of prescriptions were incomplete. Legibility and completeness are higher in unusual drugs prescriptions. The Intensive Care Section performed best as far as quality of prescription writing was concerned when compared with the Medical and Surgical Sections

Living in the "land of no"? Consumer perceptions of healthy lifestyle portrayals in direct-to-consumer advertisements of prescription drugs.

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Frosch, Dominick L; May, Suepattra G; Tietbohl, Caroline; Pagán, José A

2011-10-01

Direct-to-consumer advertising (DTCA) of prescription drugs is the most common form of health communication Americans are exposed to. The effects of DTCA on prescription requests and utilization are well established, but little is known about the effects of advertisements on health behaviors. Many advertisements, especially those promoting drugs to prevent or treat cardiovascular disease, refer to lifestyle change as a way to improve health. However, no studies have examined how consumers interpret these frequently ambiguous messages. We used in-depth interviews with 45 participants, recruited in Los Angeles, USA between April 2007 and July 2008, to explore perceptions of 5 advertisements for drugs that prevent or treat cardiovascular disease (Lipitor(®), Vytorin(®), Zetia(®), Caduet(®), Plavix(®)). We found that participants interpreted advertising messages within their own life context and identified four trajectories for enacting behavior change versus taking prescription drugs: Negotiators, Avoiders, Embracers and Jumpstarters. Underlying these four typologies were beliefs about whether lifestyle change was something an individual could do or was willing to do. Our results also show how an advertisement narrative could potentially shift perceptions of causality by suggesting that high cholesterol is primarily hereditary, thereby obviating the need for lifestyle change. Some participants stated that they would prefer lifestyle change to a particular prescription drug, but felt that others would be more likely to embrace taking a prescription drug. This "Third Person Effect" may be masking participants' intentions by identifying a more socially desirable route to therapeutic change. These findings raise questions about how the typologies are distributed in the population and how advertising may shift consumers' beliefs over time, thereby contributing to new forms of medicalization. Effective regulation of DTCA may require expanding scrutiny beyond the

Trust in online prescription drug information among internet users: the impact on information search behavior after exposure to direct-to-consumer advertising.

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Menon, Ajit M; Deshpande, Aparna D; Perri, Matthew; Zinkhan, George M

2002-01-01

The proliferation of both manufacturer-controlled and independent medication-related websites has aroused concern among consumers and policy-makers concerning the trustworthiness of Web-based drug information. The authors examine consumers' trust in on-line prescription drug information and its influence on information search behavior. The study design involves a retrospective analysis of data from a 1998 national survey. The findings reveal that trust in drug information from traditional media sources such as television and newspapers transfers to the domain of the Internet. Furthermore, a greater trust in on-line prescription drug information stimulates utilization of the Internet for information search after exposure to prescription drug advertising.

Utilization and Costs of Compounded Medications for Commercially Insured Patients, 2012-2013.

Science.gov (United States)

McPherson, Timothy; Fontane, Patrick; Iyengar, Reethi; Henderson, Rochelle

2016-02-01

Although compounding has a long-standing tradition in clinical practice, insurers and pharmacy benefit managers have instituted policies to decrease claims for compounded medications, citing questions about their safety, efficacy, high costs, and lack of FDA approval. There are no reliable published data on the extent of compounding by community pharmacists nor on the fraction of patients who use compounded medications. Prior research suggests that compounded medications represent a relatively small proportion of prescription medications, but those surveys were limited by small sample sizes, subjective data collection methods, and low response rates. To determine the number of claims for compounded medications on a per user per year (PUPY) basis and the average ingredient cost of these claims among commercially insured patients in the United States for 2012 and 2013. This study used prescription claims data from a nationally representative sample of commercially insured members whose pharmacy benefits were managed by a large pharmacy benefit management company. A retrospective claims analysis was conducted from January 1, 2012, through December 31, 2013. Annualized prevalence, cost, and utilization estimates were drawn from the data. All prescription claims were adjusted to 30-day equivalents. Data-mining techniques (association rule mining) were employed in order to identify the most commonly combined ingredients in compounded medications. The prevalence of compound users was 1.1% (245,285) of eligible members in 2012 and 1.4% (323,501) in 2013, an increase of 27.3%. Approximately 66% of compound users were female, and the average age of a compound user was approximately 42 years throughout the study period. The geographic distribution of compound user prevalence was consistent across the United States. Compound users' prescription claims increased 36.6% from 2012 to 2013, from approximately 7.1 million to approximately 9.7 million prescriptions. The number of

[Analyze prescription rules of Professor Jiang Liangduo treatment for abdominal mass based on traditional Chinese medicine inheritance platform].

Science.gov (United States)

Lian, Xiao-Xiao; Guo, Xiao-Xia

2018-01-01

To investigate the herbal prescription rules of Professor Jiang Liangduo in the treatment of abdominal mass based on the traditional Chinese medicine inheritance support system software (TCMISS) of version 2.5, find out new herbal formulas for the treatment of abdominal mass, and then provide new reference to its traditional Chinese medicine therapy. By the method of retrospective study, one hundred and thirty-two outpatient prescriptions of Professor Jiang for the treatment of abdominal mass were collected to establish a typical database with TCMISS. Four properties, five tastes, channel tropism, frequency count, Chinese herbal prescriptions rules and the new prescriptions were analyzed so as to dig out the prescription rules. There were 57 herbs with a frequency>=15, and then 91 core combinations of 2-5 herbs were evolved and 9 new prescriptions were created. It was found out that these drugs mainly had the effects of liver nourishing and soothing, soft-moist and dredging-tonifying, supporting right and dispeling evil, cooperating with the method of calming the liver and resolving hard lump according to the actual situation. It reflected the thought of treatment based on syndrome differentiation in TCM, and provided a new reference for its clinical treatment and research. Copyright© by the Chinese Pharmaceutical Association.

Prescription Drug Abuse

Science.gov (United States)

... what the doctor prescribed, it is called prescription drug abuse. It could be Taking a medicine that ... purpose, such as getting high Abusing some prescription drugs can lead to addiction. These include opioids, sedatives, ...

Communicating doses of pediatric liquid medicines to parents/caregivers: a comparison of written dosing directions on prescriptions with labels applied by dispensed pharmacy.

Science.gov (United States)

Shah, Rita; Blustein, Leona; Kuffner, Ed; Davis, Lisa

2014-03-01

To identify and compare volumetric measures used by healthcare providers in communicating dosing instructions for pediatric liquid prescriptions to parents/caregivers. Dosing instructions were retrospectively reviewed for the 10 most frequently prescribed liquid medications dispensed from 4 community pharmacies for patients aged ≤ 12 years during a 3-month period. Volumetric measures on original prescriptions (ie, milliliters, teaspoons) were compared with those utilized by the pharmacist on the pharmacy label dispensed to the parent/caregiver. Of 649 prescriptions and corresponding pharmacy labels evaluated, 68% of prescriptions and 62% of pharmacy labels communicated dosing in milliliters, 24% of prescriptions and 29% of pharmacy labels communicated dosing in teaspoonfuls, 7% of prescriptions and 0% of pharmacy labels communicated dosing in other measures (ie, milligrams, cubic centimeters, "dose"), and 25% of dispensed pharmacy labels did not reflect units as written in the prescription. Volumetric measures utilized by healthcare professionals in dosing instructions for prescription pediatric oral liquid medications are not consistent. Healthcare professionals and parents/caregivers should be educated on safe dosing practices for liquid pediatric medications. Generalizability to the larger pediatric population may vary depending on pharmacy chain, location, and medications evaluated. Copyright © 2014 Mosby, Inc. All rights reserved.

Looking at prescription quality in Ayurveda: Developing, validating and pilot testing a prescription quality index for Ayurveda.

Science.gov (United States)

Rastogi, Sanjeev

2017-11-06

Prescription quality can be a direct predictor of the net outcome of a health care delivery effort. Quality of prescription may be considered as a cumulative matrix of multiple components of a prescription on the basis of their relative importance. Prescription quality index is a recognized tool in clinical medicine for multiple purposes including the prediction of health care intervention outcome. Considering the importance of prescription quality among every system of medicine, an attempt was made to design a prescription quality index for Ayurveda. The Prescription Quality Index for Ayurveda was designed through item selection following a thorough literature search and was validated through multiple peer group discussions. Final draft of index containing 38 individual items carrying different scores as per their importance in the prescription was subjected to a pilot test upon 1576 indoor prescriptions generated in 2015 at State Ayurvedic College Hospital, Lucknow. The study revealed large information gaps in the components of the prescription where it was supposed to be noted by the prescribers. These gaps in the Ayurvedic prescriptions were most significant in the areas pertaining to Ayurvedic fundamentals of clinical examination, disease diagnosis and Ayurvedic drug intake methods. Prescription Quality Index for Ayurveda was found useful in underlining the gaps between the ideal and generated prescriptions. This can be utilized as a useful tool to evaluate the quality of Ayurvedic prescriptions by seeing their adherence to the standard prescription template. Copyright © 2017 Transdisciplinary University, Bangalore and World Ayurveda Foundation. Published by Elsevier B.V. All rights reserved.

Distribution and characteristics of occupational injuries and diseases among farmers: a retrospective analysis of workers' compensation claims.

Science.gov (United States)

Karttunen, Janne P; Rautiainen, Risto H

2013-08-01

Research indicates occupational injuries and diseases are not evenly distributed among workers. We investigated the distribution and characteristics of compensated occupational injuries and diseases requiring medical care in the Finnish farming population. The study population consisted of 93,564 Finnish farmers, spouses, and salaried family members who were covered by the mandatory workers' compensation insurance in 2002. This population had a total of 133,207 occupational injuries and 9,148 occupational diseases over a 26-year period (1982-2008). Clustering of claims was observed. Nearly half (47.1%) of the population had no compensated claims while 52.9% had at least one; 50.9% of farmers had one or more injuries and 8.1% had one or more diseases. Ten percent of the population had half of injury cases, and 3% of the population had half of occupational disease cases. Claims frequently involved work tasks related to animal husbandry and repair and maintenance of farm machinery. Injury and disease characteristics (work activity, cause, ICD-10 code) differed between individuals with high and low personal claim rate. Injuries and diseases of the musculoskeletal system had a tendency to reoccur among those with high claim rate. These outcomes were often related to strenuous working motions and postures in labor-intensive animal husbandry. Analyses of longitudinal insurance data contributes to better understanding of the long-term risk of occupational injury and disease among farmers. We suggest focusing on recurrent health outcomes and their causes among high risk populations could help design more effective interventions in agriculture and other industries. Copyright © 2013 Wiley Periodicals, Inc.

Prescription Pattern of Analgesic Drugs for Patients Receiving Palliative Care in a Teaching Hospital in India.

Science.gov (United States)

Menezes, Vishma Hydie; Nair, Shoba N; Soumya, M S; Tarey, S D

2016-01-01

Drugs used in the palliative care unit for managing symptoms are major contributors toward the expenditure occurring in palliative care. This study was conducted to understand the prescription pattern of analgesic drugs in the patients who are receiving palliative care in a teaching hospital in India by a retrospective study of case records. Case record based, retrospective, descriptive study was conducted at the Pain and Palliative Care Department of St. John's Medical College Hospital, Bengaluru. Case record files of all patients referred to Pain and Palliative Care Department for the treatment of pain in the year of 2012 were studied. Patients' age, gender, diagnoses, numerical pain rating scale (0-10), drugs prescribed, dosage, frequency, route of administration were recorded. The difference in drug utilization between the genders was done using Chi-square test. Data were collected from 502 patients of which 280 (56%) were males and 222 (44%) were females. Twelve percent of patients had mild pain (1-3), 34% had moderate pain (4-6), and 54% had severe pain (7-10). The most commonly used analgesic drugs were opioids (47%), followed by nonsteroidal anti-inflammatory drugs (36%). The opioids used were tramadol (56%), and morphine (38%). Ninety percent of patients with numerical pain scale more than 6 received morphine. There was no difference in analgesic drug utilization with regards to gender. Prescription pattern differed depending on the severity of pain. Opioids were the most commonly used drugs for pain management. The study shows that prescription pattern in palliative care unit of this hospital was in accordance with WHO pain management guidelines. The study showed the current trend in prescription of analgesic drugs in the teaching hospital where the study was conducted.

Analysis of medication-related malpractice claims: causes, preventability, and costs.

Science.gov (United States)

Rothschild, Jeffrey M; Federico, Frank A; Gandhi, Tejal K; Kaushal, Rainu; Williams, Deborah H; Bates, David W

2002-11-25

Adverse drug events (ADEs) may lead to serious injury and may result in malpractice claims. While ADEs resulting in claims are not representative of all ADEs, such data provide a useful resource for studying ADEs. Therefore, we conducted a review of medication-related malpractice claims to study their frequency, nature, and costs and to assess the human factor failures associated with preventable ADEs. We also assessed the potential benefits of proved effective ADE prevention strategies on ADE claims prevention. We conducted a retrospective analysis of a New England malpractice insurance company claims records from January 1, 1990, to December 31, 1999. Cases were electronically screened for possible ADEs and followed up by independent review of abstracts by 2 physician reviewers (T.K.G. and R.K.). Additional in-depth claims file reviews identified potential human factor failures associated with ADEs. Adverse drug events represented 6.3% (129/2040) of claims. Adverse drug events were judged preventable in 73% (n = 94) of the cases and were nearly evenly divided between outpatient and inpatient settings. The most frequently involved medication classes were antibiotics, antidepressants or antipsychotics, cardiovascular drugs, and anticoagulants. Among these ADEs, 46% were life threatening or fatal. System deficiencies and performance errors were the most frequent cause of preventable ADEs. The mean costs of defending malpractice claims due to ADEs were comparable for nonpreventable inpatient and outpatient ADEs and preventable outpatient ADEs (mean, $64,700-74,200), but costs were considerably greater for preventable inpatient ADEs (mean, $376,500). Adverse drug events associated with malpractice claims were often severe, costly, and preventable, and about half occurred in outpatients. Many interventions could potentially have prevented ADEs, with error proofing and process standardization covering the greatest proportion of events.

Economic burden of irritable bowel syndrome with constipation: a retrospective analysis of health care costs in a commercially insured population.

Science.gov (United States)

Doshi, Jalpa A; Cai, Qian; Buono, Jessica L; Spalding, William M; Sarocco, Phil; Tan, Hiangkiat; Stephenson, Judith J; Carson, Robyn T

2014-04-01

The prevalence of irritable bowel syndrome with constipation (IBS-C) is estimated to be between 4.3% and 5.2% among adults in the United States. Little is known about the health care resource utilization and costs associated with IBS-C. To (a) evaluate the annual total all-cause, gastrointestinal (GI)-related, and IBS-C-related health care costs among IBS-C patients seeking medical care in a commercially insured population and (b) estimate the incremental all-cause health care costs among IBS-C patients relative to matched controls. Patients aged ≥ 18 years with continuous medical and pharmacy benefit eligibility in 2010 were identified from the HealthCore Integrated Research Database, which consists of administrative claims from 14 geographically dispersed U.S. health plans representing 45 million lives. IBS-C patients were defined as those with ≥ 1 medical claim with an ICD-9-CM diagnosis code in any position for IBS (ICD-9-CM 564.1x) and either ≥ 2 medical claims for constipation (ICD-9-CM 564.0x) on different service dates or ≥ 1 medical claim for constipation plus ≥ 1 pharmacy claim for a constipation-related prescription on different dates of service during the study period. Controls were defined as patients without any medical claims for IBS, constipation, abdominal pain, or bloating or pharmacy claims for constipation-related prescriptions. Controls were randomly selected and matched with IBS-C patients in a 1:1 ratio based on age (± 4 years), gender, health plan region, and health plan type. Patients with diagnoses or prescriptions suggesting mixed IBS, IBS with diarrhea, chronic diarrhea, or drug-induced constipation were excluded. Total health care costs in 2010 U.S. dollars were defined as the sum of health plan and patient paid costs for prescriptions and medical services, including inpatient visits, emergency room (ER) visits, physician office visits, and other outpatient services. The total cost approach was used to assess

High rate of systemic corticosteroid prescription among outpatient visits for psoriasis: A population-based epidemiological study using the Korean National Health Insurance database.

Science.gov (United States)

Eun, Sang Jun; Jang, Sihyeok; Lee, Jin Yong; Do, Young Kyung; Jo, Seong Jin

2017-09-01

The use of systemic corticosteroids (SC) for the treatment of psoriasis is not recommended according to textbooks and guidelines. In clinical practise, however, many physicians frequently prescribe SC for patients with psoriasis. To determine the magnitude of SC prescription for outpatients with psoriasis in Korea and identify factors associated with the use of SC, we used the 2010-2014 nationwide claims data of the Health Insurance Review and Assessment Service of Korea. In frequency analysis for the full scale of prescribed SC, oral methylprednisolone was the most frequently prescribed SC, followed by dexamethasone and betamethasone injections. The prescription rate of SC was 26.4% in outpatient visit episodes for psoriasis. The prescription rate of SC was higher in older patients, Medical Aid recipients, patients who visited office-based physician practices and hospitals, and patients living in non-metropolitan areas. In multiple logistic regression analyses, the older age group and smaller health-care institutions were more associated with the SC prescription. In conclusion, SC were widely prescribed for patients with psoriasis in Korea despite the current guidelines. Both patients' individual and institutional characteristics were associated with the SC prescription. © 2017 Japanese Dermatological Association.

A prescription fraud detection model.

Science.gov (United States)

Aral, Karca Duru; Güvenir, Halil Altay; Sabuncuoğlu, Ihsan; Akar, Ahmet Ruchan

2012-04-01

Prescription fraud is a main problem that causes substantial monetary loss in health care systems. We aimed to develop a model for detecting cases of prescription fraud and test it on real world data from a large multi-center medical prescription database. Conventionally, prescription fraud detection is conducted on random samples by human experts. However, the samples might be misleading and manual detection is costly. We propose a novel distance based on data-mining approach for assessing the fraudulent risk of prescriptions regarding cross-features. Final tests have been conducted on adult cardiac surgery database. The results obtained from experiments reveal that the proposed model works considerably well with a true positive rate of 77.4% and a false positive rate of 6% for the fraudulent medical prescriptions. The proposed model has the potential advantages including on-line risk prediction for prescription fraud, off-line analysis of high-risk prescriptions by human experts, and self-learning ability by regular updates of the integrative data sets. We conclude that incorporating such a system in health authorities, social security agencies and insurance companies would improve efficiency of internal review to ensure compliance with the law, and radically decrease human-expert auditing costs. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

32 CFR 536.121 - Claims not payable as maritime claims.

Science.gov (United States)

2010-07-01

... 32 National Defense 3 2010-07-01 2010-07-01 true Claims not payable as maritime claims. 536.121... ACCOUNTS CLAIMS AGAINST THE UNITED STATES Maritime Claims § 536.121 Claims not payable as maritime claims... (except at (e) and (k)), and 536.46; (b) Are not maritime in nature; (c) Are not in the best interests of...

Visualization of medicine prescription behavior

NARCIS (Netherlands)

Corput, van der P.N.A.; Arends, J.B.A.M.; Wijk, van J.J.

2014-01-01

Medicine prescriptions play an important role in medical treatments. More insight in medicine prescription behavior can lead to more efficient and effective treatments, as well as reflection on prescription behavior for specific physicians, types of medicines, or classes of patients. Most current

Non-medical use of psychoactive prescription drugs is associated with fatal poisoning.

Science.gov (United States)

Haukka, Jari; Kriikku, Pirkko; Mariottini, Claudia; Partonen, Timo; Ojanperä, Ilkka

2018-03-01

The aims of this study were to estimate the prevalence and predictors of non-medical substance use, and to assess the association between non-medical substance use and fatal poisoning or history of drug abuse in Finland. Retrospective cohort study of all medico-legally investigated death cases in Finland. The postmortem toxicology database was linked together with the register on reimbursed prescription medicines. All postmortem cases between 2011 and 2013 positive for one or more of the following drugs: oxycodone, fentanyl, tramadol, clonazepam, gabapentin, pregabalin, tizanidine, olanzapine, quetiapine, risperidone, alprazolam, zolpidem, mirtazapine and bupropion, n = 2974. Non-medical use of substance was the outcome variable. Predictors were the following: gender, residence at the time of death, place of death, blood alcohol concentration, age, drug abuse, number of prescriptions of any psychoactive drugs in last year and proportion of prescriptions issued by psychiatrist in last year. In 50.4% of the studied cases, at least one drug was detected without a prescription. Clonazepam, alprazolam and tramadol were the most prevalent non-medical findings in these cases (6.6, 6.1 and 5.6%, respectively). The risk of non-medical use of prescription drugs was especially high in cases with history of drug abuse (88.5%) and in fatal poisonings (71.0%). The proportion of non-medical use of the studied substances varied between 5.9% [95% confidence interval (CI) = 3.1-10.1%)] for risperidone and 55.7% for fentanyl (95% CI = 44.1-66.9%). Valid prescription for one or more of any psychoactive drug was associated with lower odds for non-medical use of the studied substances. Additionally, the higher the proportion of psychoactive drugs prescribed by a psychiatrist, the lower the probability of non-medical use. Non-prescribed psychoactive drugs are found commonly at postmortem in drug poisoning deaths in Finland, with history of drug abuse being a major contributing

Analysis of the evidence-practice gap to facilitate proper medical care for the elderly: investigation, using databases, of utilization measures for National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB).

Science.gov (United States)

Nakayama, Takeo; Imanaka, Yuichi; Okuno, Yasushi; Kato, Genta; Kuroda, Tomohiro; Goto, Rei; Tanaka, Shiro; Tamura, Hiroshi; Fukuhara, Shunichi; Fukuma, Shingo; Muto, Manabu; Yanagita, Motoko; Yamamoto, Yosuke

2017-06-06

As Japan becomes a super-aging society, presentation of the best ways to provide medical care for the elderly, and the direction of that care, are important national issues. Elderly people have multi-morbidity with numerous medical conditions and use many medical resources for complex treatment patterns. This increases the likelihood of inappropriate medical practices and an evidence-practice gap. The present study aimed to: derive findings that are applicable to policy from an elucidation of the actual state of medical care for the elderly; establish a foundation for the utilization of National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB), and present measures for the utilization of existing databases in parallel with NDB validation.Cross-sectional and retrospective cohort studies were conducted using the NDB built by the Ministry of Health, Labor and Welfare of Japan, private health insurance claims databases, and the Kyoto University Hospital database (including related hospitals). Medical practices (drug prescription, interventional procedures, testing) related to four issues-potential inappropriate medication, cancer therapy, chronic kidney disease treatment, and end-of-life care-will be described. The relationships between these issues and clinical outcomes (death, initiation of dialysis and other adverse events) will be evaluated, if possible.

Continued Statin Prescriptions After Adverse Reactions and Patient Outcomes: A Cohort Study.

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Zhang, Huabing; Plutzky, Jorge; Shubina, Maria; Turchin, Alexander

2017-08-15

Many patients discontinue statin treatment, often after having a possible adverse reaction. The risks and benefits of continued statin therapy after an adverse reaction are not known. To examine the relationship between continuation of statin therapy (any prescription within 12 months after an adverse reaction) and clinical outcomes. Retrospective cohort study. Primary care practices affiliated with 2 academic medical centers. Patients with a presumed adverse reaction to a statin between 2000 and 2011. Information on adverse reactions to statins was obtained from structured electronic medical record data or natural-language processing of narrative provider notes. The primary composite outcome was time to a cardiovascular event (myocardial infarction or stroke) or death. Most (81%) of the adverse reactions to statins were identified from the text of electronic provider notes. Among 28 266 study patients, 19 989 (70.7%) continued receiving statin prescriptions after the adverse reaction. Four years after the presumed adverse event, the cumulative incidence of the composite primary outcome was 12.2% for patients with continued statin prescriptions, compared with 13.9% for those without them (difference, 1.7% [95% CI, 0.8% to 2.7%]; P statin was prescribed after the adverse reaction, 2014 (26.5%) had a documented adverse reaction to the second statin, but 1696 (84.2%) of those patients continued receiving statin prescriptions. The risk for recurrent adverse reactions to statins could not be established for the entire sample. It was also not possible to determine whether patients actually took the statins. Continued statin prescriptions after an adverse reaction were associated with a lower incidence of death and cardiovascular events. Chinese National Key Program of Clinical Science, National Natural Science Foundation of China, and Young Scientific Research Fund of Peking Union Medical College Hospital.

Quality of care in patients with atrial fibrillation in primary care: a cross-sectional study comparing clinical and claims data.

Science.gov (United States)

Preuss, Rebekka; Chenot, Jean-François; Angelow, Aniela

2016-01-01

Objectives: Atrial fibrillation (AF) is a common cardiac arrhythmia with increased risk of thromboembolic stroke. Oral anticoagulation (OAC) reduces stroke risk by up to 68%. The aim of our study was to evaluate quality of care in patients with AF in a primary health care setting with a focus on physician guideline adherence for OAC prescription and heart rate- and rhythm management. In a second step we aimed to compare OAC rates based on primary care data with rates based on claims data. Methods: We included all GP practices in the region Vorpommern-Greifswald, Germany, which were willing to participate (N=29/182, response rate 16%). Claims data was derived from the regional association of statutory health insurance physicians. Patients with a documented AF diagnosis (ICD-10-GM-Code ICD I48.-) from 07/2011-06/2012 were identified using electronic medical records (EMR) and claims data. Stroke and bleeding risk were calculated using the CHA 2 DS 2 -VASc and HAS-BLED scores. We calculated crude treatment rates for OAC, rate and rhythm control medications and adjusted OAC treatment rates based on practice and claims data. Adjusted rates were calculated including the CHA 2 DS 2 -VASc and HAS-BLED scores and individual factors affecting guideline based treatment. Results: We identified 927 patients based on EMR and 1,247 patients based on claims data. The crude total OAC treatment rate was 69% based on EMR and 61% based on claims data. The adjusted OAC treatment rates were 90% for patients based on EMR and 63% based on claims data. 82% of the AF patients received a treatment for rate control and 12% a treatment for rhythm control. The most common reasons for non-prescription of OAC were an increased risk of falling, dementia and increased bleeding risk. Conclusion: Our results suggest that a high rate of AF patients receive a drug therapy according to guidelines. There is a large difference between crude and adjusted OAC treatment rates. This is due to individual

Duration of oral antibiotic therapy for the treatment of adult acne: a retrospective analysis investigating adherence to guideline recommendations and opportunities for cost-savings.

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Straight, Chelsey E; Lee, Young H; Liu, Guodong; Kirby, Joslyn S

2015-05-01

The duration of oral antibiotic acne therapy for adolescents compared with guidelines was recently investigated; however it was uncertain if duration of antibiotics for adult acne therapy differed. This study aimed to evaluate duration of oral antibiotics for adult acne compared with guidelines and determine possible cost-savings. This was a retrospective cohort study of MarketScan Commercial Claims and Encounters database that incorporated claims data to determine duration and costs of antibiotic treatment among adults ages 21 years and older. Of 17,448 courses, 84.5% (14,737) aligned with duration guidelines, although 12,040 (69.0%) courses did not include concomitant topical retinoid therapy. Mean savings of $592.26 per person could result if prolonged courses met guidelines. Mean (median) costs of generic and branded formulations for the most frequent course duration (90-179 days) were $103.77 ($54.27) and $1421.61 ($1462.25), respectively. Actual patient prescription adherence is uncertain and database lacks information regarding acne severity, patient physical characteristics, and clinical outcomes. The majority of oral antibiotic course durations follow guidelines, although topical retinoids are underused. Costs of antibiotic therapy were lower for shorter courses and those using generic medications; the cost-effectiveness of these modifications has not been investigated. Copyright © 2015 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

32 CFR 536.129 - Claims cognizable as UCMJ claims.

Science.gov (United States)

2010-07-01

... Personnel Claims Act and chapter 11 of AR 27-20, which provides compensation only for tangible personal... 32 National Defense 3 2010-07-01 2010-07-01 true Claims cognizable as UCMJ claims. 536.129 Section 536.129 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY CLAIMS AND ACCOUNTS...

Specialist pediatric palliative care prescribing practices: A large 5-year retrospective audit

Directory of Open Access Journals (Sweden)

Anuja Damani

2016-01-01

Full Text Available Introduction: There is a gradual increasing trend in childhood cancers in India and pediatric palliative care in India is an emerging specialty. Prescribing pain and symptom control drugs in children with cancer requires knowledge of palliative care formulary, dosing schedules, and prescription guidelines. This study is a retrospective audit of prescribing practices of a specialist palliative care service situated in a tertiary cancer center. Methods: A total of 1135 medication records of children receiving specialist pediatric palliative care services were audited for 5 years (2010-2014 to evaluate prescribing practices in children with advanced cancer. Results: A total of 51 types of drugs were prescribed with an average of 4.2 drugs per prescription. 66.9% of the prescriptions had paracetamol, and 33.9% of the prescriptions had morphine. Most common nonsteroidal anti-inflammatory drugs prescribed was ibuprofen (23.9%, and more than 50% of the prescriptions had aperients. The most commonly prescribed aperient was a combination of liquid paraffin and sodium-picosulfate. Dexamethasone was prescribed in 51.9% of patients and in most cases this was part of oral chemotherapy regimen. Generic names in prescription were used only in 33% of cases, and adverse effects of the drugs were documented in only 9% of cases. In 25% of cases, noncompliance to the WHO prescription guidelines was seen, and patient compliance to prescription was seen in 40% of cases. Conclusions: Audit of the prescribing practices in specialist pediatric palliative care service shows that knowledge of pediatric palliative care formulary, rational drug use, dosing, and prescribing guidelines is essential for symptom control in children with advanced life-limiting illness. Noncompliance to WHO prescribing guidelines in one fourth of cases and using nongeneric names in two-thirds of prescription indicates poor prescribing practices and warrants prescriber education. Prescription

Statin use and risk of cholecystectomy - A case-control analysis using Swiss claims data.

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Biétry, Fabienne A; Reich, Oliver; Schwenkglenks, Matthias; Meier, Christoph R

2016-12-01

Using claims data from the Helsana Group, a large Swiss health insurance provider, we examined the association between statin use and the risk of cholecystectomy in a case-control analysis. We identified 2,200 cholecystectomy cases between 2013 and 2014 and matched 4 controls to each case on age, sex, index date and canton. We categorized statin users into current or past users (last prescription ≤ 180 or > 180 days before the index date, respectively) and classified medication use by duration based on number of prescriptions before the index date. We applied conditional logistic regression analyses to calculate odds ratios (ORs) with 95% confidence intervals (CIs) and adjusted the analyses for history of cardiovascular diseases and for use of estrogens, fibrates and other lipid-lowering agents. The adjusted OR (aOR) for cholecystectomy was 0.85 (95% CI: 0.74, 0.99) for current statin users compared to non-users. Long-term current statin use (5-19 prescriptions) was associated with a reduced OR (aOR 0.77, 95% CI: 0.65, 0.92). However, neither short-term current use nor past statin use affected the risk of cholecystectomy. The study supports the previously raised hypothesis that long-term statin use reduces the risk of cholecystectomy.

Radiopharmaceutical prescription in nuclear medicine departments

International Nuclear Information System (INIS)

Biechlin-Chassel, M.L.; Lao, S.; Bolot, C.; Francois-Joubert, A.

2010-01-01

In France, radiopharmaceutical prescription is often discussed depending to which juridical structure the nuclear medicine department is belonging. According to current regulation, this prescription is an obligation in a department linked to hospital with a pharmacy department inside. But situation remains unclear for independent nuclear medicine departments where physicians are not constrained to prescribe radiopharmaceuticals. However, as radiographers and nurses are only authorized to realize theirs acts in front of a medical prescription, one prescription must be realized. Nowadays, computerized prescription tools have been developed but only for radiopharmaceutical drugs and not for medical acts. In the aim to achieve a safer patient care, the prescription regulation may be applied whatever differences between nuclear medicines departments. (authors)

Risk of recurrent acute lower urinary tract infections and prescription pattern of antibiotics in women with and without diabetes in primary care

NARCIS (Netherlands)

Gorter, Kees J.; Hak, Eelko; Zuithoff, Nicolaas P. A.; Hoepelman, Andy I. M.; Rutten, Guy E. H. M.

Aim. To investigate diabetes characteristics associated with the risk of recurrent lower UTIs and the antibiotic prescription pattern. Methods. In an exploratory retrospective study involving 7063 women aged >= 30 years, we studied the incidence of recurrent UTI (relapses and reinfection) in women

Claim Assessment Profile: A Method for Capturing Healthcare Evidence in the Scientific Evaluation and Review of Claims in Health Care (SEaRCH).

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Hilton, Lara; Jonas, Wayne B

2017-02-01

Grounding health claims in an evidence base is essential for determining safety and effectiveness. However, it is not appropriate to evaluate all healthcare claims with the same methods. "Gold standard" randomized controlled trials may skip over important qualitative and observational data about use, benefits, side effects, and preferences, issues especially salient in research on complementary and integrative health (CIH) practices. This gap has prompted a move toward studying treatments in their naturalistic settings. In the 1990s, a program initiated under the National Institutes of Health was designed to provide an outreach to CIH practices for assessing the feasibility of conducting retrospective or prospective evaluations. The Claim Assessment Profile further develops this approach, within the framework of Samueli Institute's Scientific Evaluation and Review of Claims in Health Care (SEaRCH) method. The goals of a Claim Assessment Profile are to clarify the elements that constitute a practice, define key outcomes, and create an explanatory model of these impacts. The main objective is to determine readiness and capacity of a practice to engage in evaluation of effectiveness. This approach is informed by a variety of rapid assessment and stakeholder-driven methods. Site visits, structured qualitative interviews, surveys, and observational data on implementation provide descriptive data about the practice. Logic modeling defines inputs, processes, and outcome variables; Path modeling defines an analytic map to explore. The Claim Assessment Profile is a rapid assessment of the evaluability of a healthcare practice. The method was developed for use on CIH practices but has also been applied in resilience research and may be applied beyond the healthcare sector. Findings are meant to provide sufficient data to improve decision-making for stakeholders. This method provides an important first step for moving existing promising yet untested practices into

Women who abuse prescription opioids: findings from the Addiction Severity Index-Multimedia Version Connect prescription opioid database.

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Green, Traci C; Grimes Serrano, Jill M; Licari, Andrea; Budman, Simon H; Butler, Stephen F

2009-07-01

Evidence suggests gender differences in abuse of prescription opioids. This study aimed to describe characteristics of women who abuse prescription opioids in a treatment-seeking sample and to contrast gender differences among prescription opioid abusers. Data collected November 2005 to April 2008 derived from the Addiction Severity Index Multimedia Version Connect (ASI-MV Connect) database. Bivariate and multivariable logistic regression examined correlates of prescription opioid abuse stratified by gender. 29,906 assessments from 220 treatment centers were included, of which 12.8% (N=3821) reported past month prescription opioid abuse. Women were more likely than men to report use of any prescription opioid (29.8% females vs. 21.1% males, phistory of drug overdose. Men-specific correlates were age screen and identify those at highest risk of prescription opioid abuse. Prevention and intervention efforts with a gender-specific approach are warranted.

Trends and Determinants of Prescription Drug Use during Pregnancy and Postpartum in British Columbia, 2002-2011: A Population-Based Cohort Study.

Directory of Open Access Journals (Sweden)

Kate Smolina

Full Text Available To describe trends, patterns, and determinants of prescription drug use during pregnancy and postpartum.This is a retrospective, population-based study of all women who gave birth between January 2002 and 31 December 2011 in British Columbia, Canada. Study population consisted of 225,973 women who had 322,219 pregnancies. We examined administrative datasets containing person-specific information on filled prescriptions, hospitalizations, and medical services. Main outcome measures were filled prescriptions during pregnancy and postpartum. We used logistic regressions to examine associations between prescription drug use and maternal characteristics.Approximately two thirds of women filled a prescription during pregnancy, increasing from 60% in 2002 to 66% in 2011. The proportion of pregnant women using medicines in all three trimesters of pregnancy increased from 20% in 2002 to 27% in 2011. Use of four or more different types of prescription drug during at least one trimester increased from 8.4% in 2002 to 11.7% in 2011. Higher BMI, smoking during pregnancy, age under 25, carrying multiples, and being diagnosed with a chronic condition all significantly increased the odds of prescription drug use during pregnancy.The observed increase in the number of prescriptions and number of different drugs being dispensed suggests a trend in prescribing practices with potentially important implications for mothers, their neonates, and caregivers. Monitoring of prescribing practices and further research into the safety of most commonly prescribed medications is crucial in better understanding risks and benefits to the fetus and the mother.

Analysis of treatment patterns and persistence on branded and generic medications in major depressive disorder using retrospective claims data

Directory of Open Access Journals (Sweden)

Solem CT

2016-10-01

Full Text Available Caitlyn T Solem,1 Ahmed Shelbaya,2,3 Yin Wan,1 Chinmay G Deshpande,1 Jose Alvir,2 Elizabeth Pappadopulos2 1Pharmerit International, Real World Evidence/Data Analytics, Bethesda, MD, 2Pfizer, Inc., Global Health Outcomes, New York, NY, 3Epidemiology Department of Mailman’s School of Public Health, Columbia University Mailman School of Public Health, New York, NY, USA Background: In major depressive disorder (MDD, treatment persistence is critical to optimize symptom remission, functional recovery, and health care costs. Desvenlafaxine tends to have fewer drug interactions and better tolerability than other MDD drugs; however, its use has not been assessed in the real world.Objective: The aim of the present study is to compare medication persistence and concomitant MDD drug use with branded desvenlafaxine (Pristiq® compared with antidepressant drug groups classified as 1 branded selective serotonin reuptake inhibitors (SSRIs; ie, escitalopram [Lexapro™] and selective serotonin–norepinephrine reuptake inhibitors (SNRIs; ie, venlafaxine [Effexor®], duloxetine [Cymbalta®] and 2 generic SSRIs/SNRIs (ie, escitalopram, citalopram, venlafaxine, fluvoxamine, fluoxetine, sertraline, paroxetine, and duloxetine.Patients and methods: MDD patients (ICD-9-CM codes 296.2, 296.3, with ≥2 prescription fills for study drugs and 12-month preindex continuous enrollment from the MarketScan Commercial Claims and Encounters Database (2009–2013, were included. Time-to-treatment discontinuation (prescription gap ≥45 days was assessed using the Kaplan–Meier curve and Cox model. Concomitant MDD drug use was compared.Results: Of the 273,514 patients included, 14,379 patients were initiated with branded desvenlafaxine, 50,937 patients with other branded SSRIs/SNRIs, and 208,198 patients with generic SSRIs/SNRIs. The number of weeks for treatment discontinuation for branded desvenlafaxine were longer (40.7 [95% CI: 39.3, 42.0] compared with other branded

[Analysis on composition principles of prescriptions for stranguria in dictionary of traditional Chinese medicine prescription].

Science.gov (United States)

Sun, Jing-Chang; Wang, Miao-Miao

2014-03-01

By using traditional Chinese medicine inheritance support system to analyze the dominant experience and recessive principles of the prescriptions for stranguria in the dictionary of traditional Chinese medicine prescription (DCMP), we aim to define the medication pattern and rule and to acquire new prescriptions. In dominant experience analysis, we were able to find 22 drugs used over 50 times, including drugs of clearing heat, diuresis and relieving stranguria which are the most used and drugs of clearing heat, cooling blood, benefiting Qi and nourishing Yin. In addition, drugs of activating Qi and Xue, eliminating phlegm and removing toxic are often used, including 34 herb pairs and 5 combinations of three-taste drugs are used more than 35 times. These results fully reflect the composition principles and compatibility characteristic of prescriptions for treating stranguria in DCMP. Thirteen new prescriptions by way of recessive principle excavating were acquired. These new prescriptions might be suitable to clinical treatments of variable syndromes. This article provides an useful clue to research and produce new drugs.

The effect of chronic mild hyponatremia on bone mineral loss evaluated by retrospective national Danish patient data

DEFF Research Database (Denmark)

Kruse, Christian; Eiken, Pia; Verbalis, Joseph

2016-01-01

between 2004 and 2011, supplemented with national Danish patient diagnosis and prescription reimbursement databases, a retrospective cohort study was performed. All subjects with more than one DXA scan were included, then stratified into "normonatremia" ([Na(+)]=[137.00-147.00] mmol/L) and "mild...

Trends in oral anti-osteoporosis drug prescription in the United Kingdom between 1990 and 2012 : Variation by age, sex, geographic location and ethnicity

NARCIS (Netherlands)

van der Velde, R Y; Wyers, C E; Teesselink, E; Geusens, P P M M; van den Bergh, J P W; de Vries, F; Cooper, C; Harvey, N C; van Staa, T P

INTRODUCTION: Given the expected increase in the number of patients with osteoporosis and fragility fractures it is important to have concise information on trends in prescription rates of anti-osteoporosis drugs (AOD). METHODS: We undertook a retrospective observational study using the UK Clinical

ClaimAssociationService

Data.gov (United States)

Department of Veterans Affairs — Retrieves and updates a veteranÆs claim status and claim-rating association (claim association for current rating) from the Corporate database for a claim selected...

Patterns of dose variability in radiation prescription of breast cancer

International Nuclear Information System (INIS)

Das, Indra J.; Chee-Wai, Cheng; Fein, Douglas A.; Fowble, Barbara

1995-01-01

Objective: Radiation dose distribution varies with breast size, beam energy, beam modifiers (wedge, bolus), and beam weights. A dose variation as low as ± 5% has been observed to change outcome of the radiation treatment. Various reports suggest that radiation dose >50 Gy and dose inhomogeneity >10% have unfavorable cosmesis. It is difficult to estimate treatment outcome and compare data in various protocols due to the variability of dose prescriptions. A retrospective analysis of the pattern of dose prescription and intercomparison of various protocols is presented for the treatment of breast cancer. Materials and Methods: In this study, five prescription points were chosen to represent the commonly used protocols for breast irradiation. All these points lie on a line of height, h, of the breast apex from the posterior non-divergent beam edge at half the chest-wall separation,s . The points are located at a distance 1.5 cm, chest wall-lung interface (2-3 cm), (h(3)), (h(2)), and at isocenter. One hundred consecutive patients treated with intact breast irradiation following excisional biopsy were selected. For analysis, treatment planning was carried out without lung correction with a 6 MV beam for all patients, even though some of the patients were treated with high energy beams. Dose distributions were optimized with proper wedges and beam weights to provide a symmetrical dose distribution on the central axis plane. A multivariate analysis of the different parameters, s,h , dose at the hot spot, and doses at various prescription points were carried out. The patients were divided into three groups based on the chest-wall separations: small ( 22.0 cm). The dose distributions related to various prescription points used in different protocols were analyzed for three groups of the patients. Results: The magnitudes of the hot spots varied from +5% to +27% among the patient population, were directly related to s, and appeared to be independent of h. The hot spots

Defining hip fracture with claims data: outpatient and provider claims matter.

Science.gov (United States)

Berry, S D; Zullo, A R; McConeghy, K; Lee, Y; Daiello, L; Kiel, D P

2017-07-01

Medicare claims are commonly used to identify hip fractures, but there is no universally accepted definition. We found that a definition using inpatient claims identified fewer fractures than a definition including outpatient and provider claims. Few additional fractures were identified by including inconsistent diagnostic and procedural codes at contiguous sites. Medicare claims data is commonly used in research studies to identify hip fractures, but there is no universally accepted definition of fracture. Our purpose was to describe potential misclassification when hip fractures are defined using Medicare Part A (inpatient) claims without considering Part B (outpatient and provider) claims and when inconsistent diagnostic and procedural codes occur at contiguous fracture sites (e.g., femoral shaft or pelvic). Participants included all long-stay nursing home residents enrolled in Medicare Parts A and B fee-for-service between 1/1/2008 and 12/31/2009 with follow-up through 12/31/2011. We compared the number of hip fractures identified using only Part A claims to (1) Part A plus Part B claims and (2) Part A and Part B claims plus discordant codes at contiguous fracture sites. Among 1,257,279 long-stay residents, 40,932 (3.2%) met the definition of hip fracture using Part A claims, and 41,687 residents (3.3%) met the definition using Part B claims. 4566 hip fractures identified using Part B claims would not have been captured using Part A claims. An additional 227 hip fractures were identified after considering contiguous fracture sites. When ascertaining hip fractures, a definition using outpatient and provider claims identified 11% more fractures than a definition with only inpatient claims. Future studies should publish their definition of fracture and specify if diagnostic codes from contiguous fracture sites were used.

Increased Incidence of Spinal Abscess and Substance Abuse after Implementation of State Mandated Prescription Drug Legislation.

Science.gov (United States)

Nagar, Vittal R; Springer, Joe E; Salles, Sara

2015-10-01

To investigate the incidence of spinal abscess and substance abuse in a tertiary care hospital after state legislation titled "House Bill 1" (HB1) mandated stricter regulation of prescription drugs of abuse in Kentucky in 2012. A retrospective case series study design was used to review the incidence of spinal abscess and drug abuse diagnoses admissions from 2010 to 2014. Variances in the incidence of spinal abscess and substance abuse were plotted across this time frame. The incidence of intraspinal abscess increased 1.56-fold in 2011 (n = 26) and 2012 (n = 25) relative to 2010 (n = 16). However, in 2013, the year following implementation of HB1 legislation, the incidence of intraspinal abscess increased 2.38-fold (n = 38) and then 4.19-fold (n = 67) in 2014. The incidence of intraspinal abscess in subjects with drug abuse diagnosis remained constant between 2010 (n = 3) and 2012 (n = 3). However, it increased twofold (n = 7) in 2013 and then ninefold (n = 27) in 2014. A correlation coefficient (rSAD ) of 0.775 revealed a strong association between the increase incidence of intraspinal abscess and diagnosis of drug abuse. The results of this retrospective study demonstrate an increased incidence of intraspinal abscess associated with drug abuse after passage of HB1 legislation regulating prescriptions of controlled medications in Kentucky. This increased incidence may be related to individuals relying on nonprescription drugs of abuse due to more highly regulated access to controlled prescription medications. However, additional factors unrelated to HB1 legislation must be taken into account. Wiley Periodicals, Inc.

Prescription drug coupons: evolution and need for regulation in direct-to-consumer advertising.

Science.gov (United States)

Mackey, Tim K; Yagi, Nozomi; Liang, Bryan A

2014-01-01

Pharmaceutical marketing in the United States had undergone a shift from largely exclusively targeting physicians to considerable efforts in targeting patients through various forms of direct-to-consumer advertising ("DTCA"). This includes the use of DTCA in prescription drug coupons ("PDCs"), a new form of DTCA that offers discounts and rebates directly to consumers to lower costs of drug purchasing. Our examination of PDCs reveals that the use and types of PDC programs is expanding and includes promotion of the vast majority of top grossing pharmaceuticals. However, controversy regarding this emerging form of DTCA has given rise to health policy concerns about their overall impact on prescription drug expenditures for consumers, payers, and the health care system, and whether they lead to optimal long-term utilization of pharmaceuticals. In response to these concerns and the growing popularity of PDCs, what we propose here are clearer regulation and regulatory guidance for PDC DTCA use. This would include review for appropriate disclosure of marketing claims, increased transparency in PDC use for pharmaceutical pricing, and leveraging potential positive benefits of PDC use for vulnerable or underserved patient populations. Copyright © 2014 Elsevier Inc. All rights reserved.

Diagnosis-Prescription in the Context of Instructional Management.

Science.gov (United States)

Besel, Ronald

The usage of the terms "diagnosis" and "prescription" in the fields of medicine and electronic troubleshooting is reviewed, and a common structure for diagnosis-prescription is proposed. The diagnosis-prescription decision sequence is outlined. Prescription-without-diagnosis and diagnosis-without-prescription in education is discussed. The…

Analysis of 127 peripartum hypoxic brain injuries from closed claims registered by the Danish Patient Insurance Association

DEFF Research Database (Denmark)

Bock, J.; Christoffersen, J.K.; Hedegaard, M.

2008-01-01

: The authors retrospectively investigated peripartum hypoxic brain injuries registered by the Danish Patient Insurance Association. RESULTS: From 1992 to 2004, 127 approved claims concerning peripartum hypoxic brain injuries were registered and subsequently analysed. Thirty-eight newborns died, and a majority...

Usefulness of traditionally defined herbal properties for distinguishing prescriptions of traditional Chinese medicine from non-prescription recipes.

Science.gov (United States)

Ung, C Y; Li, H; Kong, C Y; Wang, J F; Chen, Y Z

2007-01-03

Traditional Chinese medicine (TCM) has been widely practiced and is considered as an attractive to conventional medicine. Multi-herb recipes have been routinely used in TCM. These have been formulated by using TCM-defined herbal properties (TCM-HPs), the scientific basis of which is unclear. The usefulness of TCM-HPs was evaluated by analyzing the distribution pattern of TCM-HPs of the constituent herbs in 1161 classical TCM prescriptions, which shows patterns of multi-herb correlation. Two artificial intelligence (AI) methods were used to examine whether TCM-HPs are capable of distinguishing TCM prescriptions from non-TCM recipes. Two AI systems were trained and tested by using 1161 TCM prescriptions, 11,202 non-TCM recipes, and two separate evaluation methods. These systems correctly classified 83.1-97.3% of the TCM prescriptions, 90.8-92.3% of the non-TCM recipes. These results suggest that TCM-HPs are capable of separating TCM prescriptions from non-TCM recipes, which are useful for formulating TCM prescriptions and consistent with the expected correlation between TCM-HPs and the physicochemical properties of herbal ingredients responsible for producing the collective pharmacological and other effects of specific TCM prescriptions.

By Default: The Effect of Prepopulated Prescription Quantities on Opioid Prescribing in the Emergency Department.

Science.gov (United States)

Santistevan, Jamie R; Sharp, Brian R; Hamedani, Azita G; Fruhan, Scott; Lee, Andrew W; Patterson, Brian W

2018-03-01

Opioid prescribing patterns have come under increasing scrutiny with the recent rise in opioid prescriptions, opioid misuse and abuse, and opioid-related adverse events. To date, there have been limited studies on the effect of default tablet quantities as part of emergency department (ED) electronic order entry. Our goal was to evaluate opioid prescribing patterns before and after the removal of a default quantity of 20 tablets from ED electronic order entry. We performed a retrospective observational study at a single academic, urban ED with 58,000 annual visits. We identified all adult patients (18 years or older) seen in the ED and discharged home with prescriptions for tablet forms of hydrocodone and oxycodone (including mixed formulations with acetaminophen). We compared the quantity of tablets prescribed per opioid prescription 12 months before and 10 months after the electronic order-entry prescription default quantity of 20 tablets was removed and replaced with no default quantity. No specific messaging was given to providers, to avoid influencing prescribing patterns. We used two-sample Wilcoxon rank-sum test, two-sample test of proportions, and Pearson's chi-squared tests where appropriate for statistical analysis. A total of 4,104 adult patients received discharge prescriptions for opioids in the pre-intervention period (151.6 prescriptions per 1,000 discharged adult patients), and 2,464 post-intervention (106.69 prescriptions per 1,000 discharged adult patients). The median quantity of opioid tablets prescribed decreased from 20 (interquartile ration [IQR] 10-20) to 15 (IQR 10-20) (pdefault quantity. While the most frequent quantity of tablets received in both groups was 20 tablets, the proportion of patients who received prescriptions on discharge that contained 20 tablets decreased from 0.5 (95% confidence interval [CI] [0.48-0.52]) to 0.23 (95% CI [0.21-0.24]) (pdefault quantity removal. Although the median number of tablets differed significantly

Consumer attitudes and factors related to prescription switching decisions in multitier copayment drug benefit plans.

Science.gov (United States)

Ganther-Urmie, Julie M; Nair, Kavita V; Valuck, Robert; McCollum, Marianne; Lewis, Sonya J; Turpin, Robin S

2004-03-01

To examine patient attitudes related to formulary medications and medication-related decision making in multitier copayment prescription drug plans. A cross-sectional retrospective analysis. Data were collected via mail survey from a random sample of 25,008 members of a managed care organization. The selected members were enrolled in a variety of 2- and 3-tier copayment plans and were taking prescription medication to treat 1 or more of 5 chronic disease states. Most respondents did not believe that formulary drugs were safer or more effective than nonformulary drugs, but 39.7% thought that formulary drugs were relatively less expensive. Most respondents appeared willing to consider switching from a nonformulary drug to a formulary drug with a lower copayment. The percent of respondents who reported they would be very unlikely or unlikely to switch was only 15.3% for a new prescription and 24.2% for a refill prescription. Medication efficacy and physician opinion were important factors in plan members' switching decisions. Cost was an important factor for some members, but older plan members were less likely to report that cost was important. Multitier plan members generally believed that drugs are placed on the formulary for reasons of cost rather than safety or efficacy. Most plan members were receptive to switching from a nonformulary to a formulary medication, but financial incentives alone may not convince some plan members to make the switch.

A new prescription for soft gluon resummation

International Nuclear Information System (INIS)

Abbate, Riccardo; Forte, Stefano; Ridolfi, Giovanni

2007-01-01

We present a new prescription for the resummation of the divergent series of perturbative corrections, due to soft gluon emission, to hard processes near threshold in perturbative QCD (threshold resummation). This prescription is based on Borel resummation, and contrary to the commonly used minimal prescription, it does not introduce a dependence of resummed physical observables on the kinematically unaccessible x→0 region of parton distributions. We compare results for resummed deep-inelastic scattering obtained using the Borel prescription and the minimal prescription and exploit the comparison to discuss the ambiguities related to the resummation procedure

[Prescription, dispensing, and regulation of psychoactive anorexigenic drugs in Belo Horizonte, Minas Gerais, Brazil].

Science.gov (United States)

Carneiro, Mônica de Fátima Gontijo; Guerra, Augusto Afonso; Acurcio, Francisco de Assis

2008-08-01

This retrospective study in Belo Horizonte, Minas Gerais, Brazil, aimed to provide indicators on the sale and consumption of anorexigenic substances. During the first stage, 2,906 of 168,237 prescriptions received by pharmacies in 2003 were analyzed, showing low quality of prescriptions. Projected consumption in defined daily doses was 19.75 DDD/1,000 inhabitants/day in 2003. Fenproporex (59.8%) was the most widely consumed drug. One pharmacy was responsible for 39.8% of the pharmaceutical sales. During the second stage, 14,554 sales records from this "blockbuster" pharmacy were analyzed, from April to August 2005; 9.2% of sales were for anorexigenic products, 91.8% of which prescribed in association with another substance. The data suggest irrational use of anorexigenic drugs by these consumers and highlight the need for proper regulation of these products. It is important to understand both the role of pharmacies in this regulation and that of physicians in the rational use of these substances.

Does Medical Cannabis Use Increase or Decrease the Use of Opioid Analgesics and Other Prescription Drugs?

Science.gov (United States)

Bachhuber, Marcus A; Arnsten, Julia H; Cunningham, Chinazo O; Sohler, Nancy

2018-04-17

: In observational and retrospective studies, people who use cannabis are more likely than people who do not use cannabis to also use other drugs. People who take medical cannabis are also more likely to report medical and non-medical use of opioid analgesics, stimulants, and tranquilizers. Given that people who take medical cannabis and those who do not are likely to have different underlying morbidity, it is possible that medical cannabis use reduces prescription drug use yet prescription drug use remains relatively high. Studies comparing people who take medical cannabis with people who do not take it cannot draw conclusions about the effect of medical cannabis on drug use. To fully understand the effect of medical cannabis on the use of other drugs, prospective longitudinal studies randomizing individuals to cannabis versus other treatments are urgently needed.

The Danish National Prescription Registry

DEFF Research Database (Denmark)

Kildemoes, Helle Wallach; Toft Sørensen, Henrik; Hallas, Jesper

2011-01-01

Introduction: Individual-level data on all prescription drugs sold in Danish community pharmacies has since 1994 been recorded in the Register of Medicinal Products Statistics of the Danish Medicines Agency. Content: The register subset, termed the Danish National Prescription Registry (DNPR......), contains information on dispensed prescriptions, including variables at the level of the drug user, the prescriber, and the pharmacy. Validity and coverage: Reimbursement-driven record keeping, with automated bar-code-based data entry provides data of high quality, including detailed information...

Prescription drug abuse: problem, policies, and implications.

Science.gov (United States)

Phillips, Janice

2013-01-01

This article provides an overview on prescription drug abuse and highlights a number of related legislative bills introduced during the 112th Congress in response to this growing epidemic. Prescription drug abuse has emerged as the nation's fastest growing drug problem. Although prescription drugs have been used effectively and appropriately for decades, deaths from prescription pain medicine in particular have reached epidemic proportions. Bills related to prescription drug abuse introduced during the 112th Congress focus on strengthening provider and consumer education, tracking and monitoring prescription drug abuse, improving data collection on drug overdose fatalities, combating fraud and abuse in Medicare and Medicaid programs, reclassifying drugs to make them more difficult to prescribe and obtain, and enforcing stricter penalties for individuals who operate scam pain clinics and sell pain pills illegitimately. This article underscores the importance of a multifaceted approach to combating prescription drug abuse and concludes with implications for nursing. Copyright © 2013. Published by Mosby, Inc.

Prescribing patterns for upper respiratory tract infections: a prescription-review of primary care practice in Kedah, Malaysia, and the implications.

Science.gov (United States)

Rezal, Rabiatul Salmi; Hassali, Mohamed Azmi; Alrasheedy, Alian A; Saleem, Fahad; Yusof, Faridah Aryani Md; Kamal, Mardhiyah; Mohd Din, Rosminah; Godman, Brian

2015-01-01

It is necessary to ascertain current prescribing of antibiotics for upper respiratory tract infections (URTIs) to address potential overuse. A retrospective analysis was conducted of all prescriptions for URTIs among 10 public primary healthcare centers in Kedah, Malaysia, from 1 January to 31 March 2014. A total of 123,524 prescriptions were screened and analyzed. Of these, 7129 prescriptions were for URTI, with 31.8% (n = 2269) containing antibiotics. Macrolides were the most commonly prescribed antibiotic, constituting 61% (n = 1403) of total antibiotics prescribed. There was a statistically significant association between different prescribers and diagnoses (p = 0.001) and a weak positive trend suggesting family medicine specialists are more competent in antibiotic prescribing, followed by medical officers and assistant medical officers (τ = 0.122). Prescribing practices of some prescribers were inconsistent with current guidelines encouraging resistance development. National antimicrobial stewardship programs and further educational initiatives are ongoing in Malaysia to improve antibiotic use.

Assessment of clinical outcomes of Roth and MBT bracket prescription using the American Board of Orthodontics Objective Grading System

Directory of Open Access Journals (Sweden)

Mahesh Jain

2013-01-01

Full Text Available Background: There is always a need to assess whether small changes in bracket prescription can lead to visually detectable differences in tooth positions. However, with little clinical evidence to show advantages of any of the popularly used bracket systems, orthodontists are forced to make clinical decisions with little scientific guidance. Aim: To compare the orthodontic cases finished with Roth and MBT prescription using American Board of Orthodontics-Objective Grading System (ABO-OGS. Settings and Design: Department of Orthodontics, Post-graduate dental college, retrospective cross-sectional study. Materials and Methods: Forty patients selected were divided into two groups of 20 patients each finished with straight wire appliance using Roth and MBT prescription, respectively. The examiner ability was assessed and calibrated by one of the ABO certified clinician to grade cases using the OGS. Statistical Analysis: Unpaired student t-test was used and P < 0.05 was accepted as significant. Results and Conclusions: MBT bracket group had a lower score of 2.60 points in buccolingual inclination and lower score of 1.10 points in occlusal contact category that was statistically significant when compared with Roth group. The difference in total ABO-OGS score was 2.65 points showing that the outcome for the MBT prescription was better than that of the Roth prescription, which is statistically significant, but with little or no clinical significance. It can be concluded that use of either one of the Roth and MBT bracket prescriptions have no impact to the overall clinical outcome and quality of treatment entirely depends on clinician judgment and experience.

The prescribing of contraceptives for adolescents in German gynecologic practices in 2007 and 2011: a retrospective database analysis.

Science.gov (United States)

Ziller, M; Rashed, A N; Ziller, V; Kostev, K

2013-10-01

To investigate the prescribing trend of contraceptives in adolescent girls aged 12-18 years and to compare prescribing patterns of the most frequently used contraceptives among this population in Germany in 2007 and 2011. A retrospective cohort study was conducted to analyze contraceptive prescriptions written by gynecologists in 2007 and 2011 in Germany by using the IMS Disease Analyzer database (IMS HEALTH). All adolescent girls aged 12-18 years with at least 1 prescription of a contraceptive drug in 2007 or 2011 were identified. The prevalence of contraceptive prescriptions was calculated and the types of contraceptive substances prescribed were examined. A total of 21,026 teenage girls in 2007 and 18,969 in 2011 received contraceptive prescriptions. The prevalence of contraceptive prescribing rose significantly between 2007 and 2011 (P contraceptive pills containing drospirenone or desogestrel significantly decreased in 2011 compared to 2007 (P contraceptive prescription usage among adolescent girls between 2007 and 2011 in Germany. However, the prescription behavior of doctors also changed; they consequently prescribed contraceptives with more evidence. Further research is needed to better understand the various factors associated with contraceptive use among this population. Copyright © 2013 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

Alcohol and prescription drug safety in older adults

Directory of Open Access Journals (Sweden)

Zanjani F

2013-02-01

Full Text Available Faika Zanjani,1,2 Aasha I Hoogland,1 Brian G Downer11Department of Gerontology, 2Building Interdisciplinary Research Careers in Women's Health University of Kentucky, Lexington, KY, USABackground: The objectives of this study were to investigate older adults' knowledge of prescription drug safety and interactions with alcohol, and to identify pharmacists' willingness to disseminate prescription drug safety information to older adults.Methods: The convenience sample consisted of 48 older adults aged 54–89 years who were recruited from a local pharmacy and who completed surveys addressing their alcohol consumption, understanding of alcohol and prescription drug interactions, and willingness to change habits regarding alcohol consumption and prescription drugs. To address pharmacist willingness, 90 pharmacists from local pharmacies volunteered and answered questions regarding their willingness to convey prescription drug safety information to older adults.Results: Older adults reported low knowledge of alcohol and prescription drug safety, with women tending to be slightly more knowledgeable. More importantly, those who drank in the previous few months were less willing to talk to family and friends about how alcohol can have harmful interactions with prescription drugs, or to be an advocate for safe alcohol and prescription drug use than those who had not had a drink recently. Pharmacists reported that they were willing to convey prescription drug safety information to older adults via a variety of formats, including displaying or distributing a flyer, and directly administering a brief intervention.Conclusion: In this study, older adults were found to have inadequate knowledge of prescription drug safety and interactions with alcohol, but pharmacists who regularly come in contact with older adults indicated that they were ready and willing to talk to older adults about prescription drug safety. Future research should focus on interventions

Assessment of parental understanding of paediatric medical prescriptions

Directory of Open Access Journals (Sweden)

Sadiqua Anjum, Nasir Mohiuddin M, Narayan Reddy U, Narsing Rao J, Sana Afreen, Mir S Adil, Javeedullah M

2014-07-01

Full Text Available Introduction: Medical prescriptions are bound to be misinterpreted by patients and pharmacists if not properly conveyed. Pediatric prescriptions differ from adult prescriptions having wide variation in doses and formulations. There is a need to evaluate the lacunae in the parental understanding of pediatric prescriptions. Aims and objective: To evaluate the parental understanding of pediatric prescription and to evaluate the adequacy of communication with the physician and pharmacist regarding the same. Material and methods: 550 parents were enrolled and their literacy level was noted. They were subjected to modify MUSE questionnaire. Physician’s prescription was analyzed in terms of ease of understanding by parents. These parents were followed up till the pharmacies and the pharmacist understanding of prescription was analyzed and their communication with parents regarding drug usage was noted. Finally, ease of usage of drugs by parents was noted. Results: MUSE scale was modified to suit pediatric prescription understanding by parents and also additional questions were asked to include complete parental understanding of doctor’s prescription. Majority of parents failed to completely understand the written prescription. Though around 80% of pharmacist could understand the prescription, their communication with parents was poor resulting in difficulty for parents to even enquire about medicines from them. Parental overall understanding of prescription increased with their literacy levels. Conclusion: Not all prescriptions are completely understood by parents as well as a pharmacist. This can lead to misuse of drugs. Efforts to explain the drug usage are not adequate enough from the doctor or the pharmacist. While communicating literacy levels of parents is not being considered which may further worsen the understanding ability

[Drug interactions in chronic prescription].

Science.gov (United States)

Comet, D; Casajuana, J; Bordas, J M; Fuentes, M A; Arnáiz, J A; Núñez, B; Pou, R

1997-06-30

Application of computerized program for detection of potential drug interactions (PDI) in chronic prescriptions in four primary care centers. To evaluate the clinical significance of PDI identified according to clinical criterions. An observational crossover study. Clutat Vella health district (City of Barcelona). Using information of Consejo General de Colegios Oficiales de Farmaceuticos databases and the chronic prescriptions database of the primary care centers, computerized drug-interaction system have been developed for detection of PDI in patients. A panel of primary care physicians and clinical pharmacists developed criteria that were used to evaluate the clinical significance of PDI. 9840 Cards of Authorized Prescription (CAP) were analyzed, 36108 medicaments and 42877 drugs. A total of 2140 patients were involved for a total of 3406 PDI, 21.75% of patients with CAP. Clinical signification for the panel was found in 40.07% of these 3406 PIF; 3.78% were suggest to avoid the association drugs. The incidence of PDI with clinical signification are lower than other studies of the literature; it suggest a appropriate knowledge of drug prescription. The application of computerized program make much more easy the detection of adverse drug interactions in chronic prescription.

Increasing Direct Care Staff Compliance to Individualized Physical Therapy Body Positioning Prescriptions: Prescriptive Checklists.

Science.gov (United States)

Lattimore, Jennifer; And Others

1984-01-01

The study confirmed previous research indicating that workshop training by itself is an ineffective method of increasing direct care staff compliance to treatment prescriptions, and that providing direct staff supervisors with a training and management tool (prescriptive checklists) may be an effective alternative for serving multihandicapped…

[Hospital fluoroquinolone prescription habits in northern France].

Science.gov (United States)

Levent, T; Cabaret, P

2010-09-01

The aim of the study was to assess the good use organization and fluoroquinolone prescription habits in cases of bone and joint, urinary, pulmonary, and digestive infections. A declarative survey was made (questionnaire for the hospital and for the prescriber). Thirty percent (44/145) of hospitals participated with 274 prescribers. Eighty percent had prescription protocols, 71 % of clinicians had access to epidemiologic data. A percentage of 30.7 (853/2,771) of prescriptions included a fluoroquinolone, 44.5 % (380/853) among these had not been recommended. The excessive prescription reached 24.4 % (116/474) in case of bone and joint infection, 14.6 % (107/731), and 20 % (157/779) in cases of digestive and respiratory infection respectively. Prescriptions for urinary infection were adequate in 47.6 % (375/787) of cases. Inadequate prescriptions were made because of bad knowledge of bacteria resistance epidemiology and pharmacology (insufficient dose, monotherapy at risk of selection), and non-application of good practice recommendations. This study justifies the rationalization of antibiotic prescription. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

[Analysis on traditional Chinese medicine prescriptions treating cancer based on traditional Chinese medicine inheritance assistance system and discovery of new prescriptions].

Science.gov (United States)

Yu, Ming; Cao, Qi-chen; Su, Yu-xi; Sui, Xin; Yang, Hong-jun; Huang, Lu-qi; Wang, Wen-ping

2015-08-01

Malignant tumor is one of the main causes for death in the world at present as well as a major disease seriously harming human health and life and restricting the social and economic development. There are many kinds of reports about traditional Chinese medicine patent prescriptions, empirical prescriptions and self-made prescriptions treating cancer, and prescription rules were often analyzed based on medication frequency. Such methods were applicable for discovering dominant experience but hard to have an innovative discovery and knowledge. In this paper, based on the traditional Chinese medicine inheritance assistance system, the software integration of mutual information improvement method, complex system entropy clustering and unsupervised entropy-level clustering data mining methods was adopted to analyze the rules of traditional Chinese medicine prescriptions for cancer. Totally 114 prescriptions were selected, the frequency of herbs in prescription was determined, and 85 core combinations and 13 new prescriptions were indentified. The traditional Chinese medicine inheritance assistance system, as a valuable traditional Chinese medicine research-supporting tool, can be used to record, manage, inquire and analyze prescription data.

Radiopharmaceutical prescription in nuclear medicine departments; La prescription medicale des radiopharmaceutiques au sein d'un service de medecine nucleaire

Energy Technology Data Exchange (ETDEWEB)

Biechlin-Chassel, M.L. [Radiopharmacie, service de pharmacie, Centre hospitalier de Chambery, 73 - Chambery (France); Lao, S. [Service de medecine nucleaire, CHU-Hopital de l' Archet, 06 - Nice (France); Bolot, C. [Service de pharmacie, hospices civiles de Lyon, groupement hospitalier Est, 69 - Bron (France); Francois-Joubert, A. [Service de medecine nucleaire, centre hospitalier de Chambery, 73 - Chambery (France)

2010-11-15

In France, radiopharmaceutical prescription is often discussed depending to which juridical structure the nuclear medicine department is belonging. According to current regulation, this prescription is an obligation in a department linked to hospital with a pharmacy department inside. But situation remains unclear for independent nuclear medicine departments where physicians are not constrained to prescribe radiopharmaceuticals. However, as radiographers and nurses are only authorized to realize theirs acts in front of a medical prescription, one prescription must be realized. Nowadays, computerized prescription tools have been developed but only for radiopharmaceutical drugs and not for medical acts. In the aim to achieve a safer patient care, the prescription regulation may be applied whatever differences between nuclear medicines departments. (authors)

Prescription drugs: issues of cost, coverage, and quality.

Science.gov (United States)

Copeland, C

1999-04-01

This Issue Brief closely examines expenditures on prescription drugs, and discusses their potential to substitute for other types of health care services. In addition, it describes employer coverage of prescription drugs, direct-to-consumer advertising of prescription drugs, and potential legislation affecting the prescription drug market. Prescription drug expenditures grew at double-digit rates during almost every year since 1980, accelerating to 14.1 percent in 1997. In contrast, total national health expenditures, hospital service expenditures, and physician service expenditures growth rates decreased from approximately 13 percent in 1980 to less than 5 percent in 1997. Private insurance payments for prescription drugs increased 17.7 percent in 1997, after growing 22.1 percent in 1995 and 18.3 percent in 1996. This growth in prescription drug payments compares with 4 percent or less overall annual growth in private insurance payments for each of those three years. From 1993 to 1997, the overwhelming majority of the increases in expenditures on prescription drugs were attributable to increased volume, mix, and availability of pharmaceutical products. In 1997, these factors accounted for more than 80 percent of the growth in prescription drug expenditures. A leading explanation for the sharp growth in drug expenditures is that prescription drugs are a substitute for other forms of health care. While it is difficult to determine the extent to which this substitution occurs, various studies have associated cost savings with the use of pharmaceutical products in treating specific diseases. Evidence suggests that more appropriate utilization of prescription drugs has the potential to lower total expenditures and improve the quality of care. Also, some studies indicate the U.S. health care system needs to improve the way patients use and physicians prescribe current medications. Prescription drug plans offered by employers are likely to undergo changes to ensure that

75 FR 16235 - Electronic Prescriptions for Controlled Substances

Science.gov (United States)

2010-03-31

... mature standard for the formatting of prescription data, most electronic prescriptions are routed from... prescriptions prior to granting access to sign such prescriptions, two-factor authentication including a hard... practitioner can retain control of a biometric or hard token. Authentication based only on knowledge factors is...

Pediatric radiology malpractice claims - characteristics and comparison to adult radiology claims

Energy Technology Data Exchange (ETDEWEB)

Breen, Micheal A.; Taylor, George A. [Boston Children' s Hospital, Department of Radiology, Boston, MA (United States); Dwyer, Kathy; Yu-Moe, Winnie [CRICO Risk Management Foundation, Boston, MA (United States)

2017-06-15

Medical malpractice is the primary method by which people who believe they have suffered an injury in the course of medical care seek compensation in the United States and Canada. An increasing body of research demonstrates that failure to correctly diagnose is the most common allegation made in malpractice claims against radiologists. Since the 1994 survey by the Society of Chairmen of Radiology in Children's Hospitals (SCORCH), no other published studies have specifically examined the frequency or clinical context of malpractice claims against pediatric radiologists or arising from pediatric imaging interpretation. We hypothesize that the frequency, character and outcome of malpractice claims made against pediatric radiologists differ from those seen in general radiology practice. We searched the Controlled Risk Insurance Co. (CRICO) Strategies' Comparative Benchmarking System (CBS), a private repository of approximately 350,000 open and closed medical malpractice claims in the United States, for claims related to pediatric radiology. We further queried these cases for the major allegation, the clinical environment in which the claim arose, the clinical severity of the alleged injury, indemnity paid (if payment was made), primary imaging modality involved (if applicable) and primary International Classification of Diseases, 9th revision (ICD-9) diagnosis underlying the claim. There were a total of 27,056 fully coded claims of medical malpractice in the CBS database in the 5-year period between Jan. 1, 2010, and Dec. 31, 2014. Of these, 1,472 cases (5.4%) involved patients younger than 18 years. Radiology was the primary service responsible for 71/1,472 (4.8%) pediatric cases. There were statistically significant differences in average payout for pediatric radiology claims ($314,671) compared to adult radiology claims ($174,033). The allegations were primarily diagnosis-related in 70% of pediatric radiology claims. The most common imaging modality

Pediatric radiology malpractice claims - characteristics and comparison to adult radiology claims

International Nuclear Information System (INIS)

Breen, Micheal A.; Taylor, George A.; Dwyer, Kathy; Yu-Moe, Winnie

2017-01-01

Medical malpractice is the primary method by which people who believe they have suffered an injury in the course of medical care seek compensation in the United States and Canada. An increasing body of research demonstrates that failure to correctly diagnose is the most common allegation made in malpractice claims against radiologists. Since the 1994 survey by the Society of Chairmen of Radiology in Children's Hospitals (SCORCH), no other published studies have specifically examined the frequency or clinical context of malpractice claims against pediatric radiologists or arising from pediatric imaging interpretation. We hypothesize that the frequency, character and outcome of malpractice claims made against pediatric radiologists differ from those seen in general radiology practice. We searched the Controlled Risk Insurance Co. (CRICO) Strategies' Comparative Benchmarking System (CBS), a private repository of approximately 350,000 open and closed medical malpractice claims in the United States, for claims related to pediatric radiology. We further queried these cases for the major allegation, the clinical environment in which the claim arose, the clinical severity of the alleged injury, indemnity paid (if payment was made), primary imaging modality involved (if applicable) and primary International Classification of Diseases, 9th revision (ICD-9) diagnosis underlying the claim. There were a total of 27,056 fully coded claims of medical malpractice in the CBS database in the 5-year period between Jan. 1, 2010, and Dec. 31, 2014. Of these, 1,472 cases (5.4%) involved patients younger than 18 years. Radiology was the primary service responsible for 71/1,472 (4.8%) pediatric cases. There were statistically significant differences in average payout for pediatric radiology claims ($314,671) compared to adult radiology claims ($174,033). The allegations were primarily diagnosis-related in 70% of pediatric radiology claims. The most common imaging modality implicated in

Pediatric radiology malpractice claims - characteristics and comparison to adult radiology claims.

Science.gov (United States)

Breen, Micheál A; Dwyer, Kathy; Yu-Moe, Winnie; Taylor, George A

2017-06-01

Medical malpractice is the primary method by which people who believe they have suffered an injury in the course of medical care seek compensation in the United States and Canada. An increasing body of research demonstrates that failure to correctly diagnose is the most common allegation made in malpractice claims against radiologists. Since the 1994 survey by the Society of Chairmen of Radiology in Children's Hospitals (SCORCH), no other published studies have specifically examined the frequency or clinical context of malpractice claims against pediatric radiologists or arising from pediatric imaging interpretation. We hypothesize that the frequency, character and outcome of malpractice claims made against pediatric radiologists differ from those seen in general radiology practice. We searched the Controlled Risk Insurance Co. (CRICO) Strategies' Comparative Benchmarking System (CBS), a private repository of approximately 350,000 open and closed medical malpractice claims in the United States, for claims related to pediatric radiology. We further queried these cases for the major allegation, the clinical environment in which the claim arose, the clinical severity of the alleged injury, indemnity paid (if payment was made), primary imaging modality involved (if applicable) and primary International Classification of Diseases, 9th revision (ICD-9) diagnosis underlying the claim. There were a total of 27,056 fully coded claims of medical malpractice in the CBS database in the 5-year period between Jan. 1, 2010, and Dec. 31, 2014. Of these, 1,472 cases (5.4%) involved patients younger than 18 years. Radiology was the primary service responsible for 71/1,472 (4.8%) pediatric cases. There were statistically significant differences in average payout for pediatric radiology claims ($314,671) compared to adult radiology claims ($174,033). The allegations were primarily diagnosis-related in 70% of pediatric radiology claims. The most common imaging modality implicated in

The Effect of Florida Medicaid's State-Mandated Formulary Provision on Prescription Drug Use and Health Plan Costs in a Medicaid Managed Care Plan.

Science.gov (United States)

Munshi, Kiraat D; Mager, Douglas; Ward, Krista M; Mischel, Brian; Henderson, Rochelle R

2018-02-01

Formulary or preferred drug list (PDL) management is an effective strategy to ensure clinically efficient prescription drug management by managed care organizations (MCOs). Medicaid MCOs participating in Florida's Medicaid program were required to use a state-mandated PDL between May and August 2014. To examine differences in prescription drug use and plan costs between a single Florida Medicaid managed care (MMC) health plan that implemented a state-mandated PDL policy on July 1, 2014, and a comparable MMC health plan in another state without a state-mandated PDL, controlling for sociodemographic confounders. A retrospective analysis with a pre-post design was conducted using deidentified administrative claims data from a large pharmacy benefit manager. The prepolicy evaluation period was January 1 through June 30, 2014, and the postpolicy period was January 1 through June 30, 2015. Continuously eligible Florida MMC plan members were matched on sociodemographic and health characteristics to their counterparts enrolled in a comparable MMC health plan in another state without a state-mandated formulary. Outcomes were drug use, measured as the number of 30-day adjusted nonspecialty drug prescriptions per member per period, and total drug plan costs per member per period for all drugs, with separate measures for generic and brand drugs. Bivariate comparisons were conducted using t-tests. Employing a difference-in-differences (DID) analytic approach, multivariate negative binomial regression and generalized estimating equation models were used to analyze prescription drug use and costs. The final analytical sample consisted of 18,372 enrollees, evenly divided between the 2 groups. In the postpolicy evaluation period, overall and generic use declined, while brand use increased for members in the Florida health plan. Drug costs, especially for brands, significantly increased for Florida health plan members. No significant changes were observed over the same time period

Delayed Detection of Esophageal Intubation in Anesthesia Malpractice Claims: Brief Report of a Case Series.

Science.gov (United States)

Honardar, Marzieh R; Posner, Karen L; Domino, Karen B

2017-12-01

This retrospective case series analyzed 45 malpractice claims for delayed detection of esophageal intubation from the Anesthesia Closed Claims Project. Inclusion criteria were cases from 1995 to 2013, after adoption of identification of CO2 in expired gas to verify correct endotracheal tube position as a monitoring standard by the American Society of Anesthesiologists. Forty-nine percent (95% confidence interval 34%-64%) occurred in the operating room or other anesthesia location where CO2 detection equipment should have been available. The most common factors contributing to delayed detection were not using, ignoring, or misinterpreting CO2 readings. Misdiagnosis, as with bronchospasm, occurred in 33% (95% confidence interval 20%).

[Standardization of names in prescriptions of traditional Chinese medicines].

Science.gov (United States)

Li, Chao-Feng; Zhang, Yu-Jun; Fan, Dong-He; Zhang, Meng-Jie; Bai, Xue; Yang, Wen-Hua; Qi, Shu-Ya; Zhang, Zhi-Jie; Xue, Chun-Miao; Mao, Liu-Ying; Cao, Jun-Ling

2017-01-01

Chinese medicine prescriptions are a type of medical documents written by doctors after they understand the patients' conditions for syndrome differentiation. Chinese medicine prescriptions are also the basis for pharmacy personnel to dispense medicines and guide patients to use drugs. It has the legal, technical and economic significances. Chinese medicine prescriptions contain such information of names, quantity and usage. Whether the names of drugs in Chinese medicine prescriptions are standardized or not is directly related to the safety and efficacy of the drugs. At present, nonstandard clinical prescriptions are frequently seen. With "Chinese medicine prescription", "names of drug in Chinese medicine prescription" and "standards of Chinese medicine prescription" as key words, the author searched CNKI, Wanfang and other databases, and consulted nearly 100 literatures, so as to summarize current names of drugs in traditional Chinese medicine prescription, analyze the reasons, and give suggestions, in the expectation of standardizing the names of drugs used in traditional Chinese medicine prescriptions. Copyright© by the Chinese Pharmaceutical Association.

Abuse of prescription medicines in southwestern France.

Science.gov (United States)

Baumevieille, M; Haramburu, F; Bégaud, B

1997-01-01

Few quantitative data are available concerning abuse of medicine in the general population, although dependence on prescription medicines involves a significant proportion of the population. Falsified prescription forms can be used as an indicator of abuse. Community pharmacists in a representative network were asked to report any falsified prescription form presented over a 1-year period. Sales data were used to express results as abuse rate and abuse rate ratio. Two-thirds of the 130 pharmacies in the network reported at least 1 falsified prescription. The reported incidence of falsified prescriptions was 2.3 per 10 000 inhabitants. A total of 392 falsified prescription forms was collected. The abuse rate ratios were 171 (95% CI 140 to 210) for dextroamphetamine-phenobarbital in combination, 168 (95% CI 131 to 216) for fenozolone, 67 (95% CI 53 to 84) for buprenorphine, and 40.5 (95% CI 33 to 50) for clobenzorex. These results show the efficiency of a method for detecting falsified prescriptions forms using community pharmacists. The abuse of medicines already known for their addictive potential can be estimated and alerts can also be detected.

BenefitClaimWebServiceBean/BenefitClaimWebService

Data.gov (United States)

Department of Veterans Affairs — A formal or informal request for a type of monetary or non-monetary benefit. This service provides benefit claims and benefit claim special issues data, allows the...

Prescription Drug Abuse and Youth. Information Brief.

Science.gov (United States)

Department of Justice, Washington, DC. National Drug Intelligence Center.

Prescription drugs, a category of psychotherapeutics that comprises prescription-type pain relievers, tranquilizers, stimulants, and sedatives, are among the substances most commonly abused by young people in the United States. Prescription drugs are readily available and can easily be obtained by teenagers who abuse these drugs to experience a…

Assessment of legibility and completeness of handwritten and electronic prescriptions.

Science.gov (United States)

Albarrak, Ahmed I; Al Rashidi, Eman Abdulrahman; Fatani, Rwaa Kamil; Al Ageel, Shoog Ibrahim; Mohammed, Rafiuddin

2014-12-01

To assess the legibility and completeness of handwritten prescriptions and compare with electronic prescription system for medication errors. Prospective study. King Khalid University Hospital (KKUH), Riyadh, Saudi Arabia. Handwritten prescriptions were received from clinical units of Medicine Outpatient Department (MOPD), Primary Care Clinic (PCC) and Surgery Outpatient Department (SOPD) whereas electronic prescriptions were collected from the pediatric ward. The handwritten prescription was assessed for completeness by the checklist designed according to the hospital prescription and evaluated for legibility by two pharmacists. The comparison between handwritten and electronic prescription errors was evaluated based on the validated checklist adopted from previous studies. Legibility and completeness of prescriptions. 398 prescriptions (199 handwritten and 199 e-prescriptions) were assessed. About 71 (35.7%) of handwritten and 5 (2.5%) of electronic prescription errors were identified. A significant statistical difference (P prescriptions in omitted dose and omitted route of administration category of error distribution. The rate of completeness in patient identification in handwritten prescriptions was 80.97% in MOPD, 76.36% in PCC and 85.93% in SOPD clinic units. Assessment of medication prescription completeness was 91.48% in MOPD, 88.48% in PCC, and 89.28% in SOPD. This study revealed a high incidence of prescribing errors in handwritten prescriptions. The use of e-prescription system showed a significant decline in the incidence of errors. The legibility of handwritten prescriptions was relatively good whereas the level of completeness was very low.

Prescribing error at hospital discharge: a retrospective review of medication information in an Irish hospital.

Science.gov (United States)

Michaelson, M; Walsh, E; Bradley, C P; McCague, P; Owens, R; Sahm, L J

2017-08-01

Prescribing error may result in adverse clinical outcomes leading to increased patient morbidity, mortality and increased economic burden. Many errors occur during transitional care as patients move between different stages and settings of care. To conduct a review of medication information and identify prescribing error among an adult population in an urban hospital. Retrospective review of medication information was conducted. Part 1: an audit of discharge prescriptions which assessed: legibility, compliance with legal requirements, therapeutic errors (strength, dose and frequency) and drug interactions. Part 2: A review of all sources of medication information (namely pre-admission medication list, drug Kardex, discharge prescription, discharge letter) for 15 inpatients to identify unintentional prescription discrepancies, defined as: "undocumented and/or unjustified medication alteration" throughout the hospital stay. Part 1: of the 5910 prescribed items; 53 (0.9%) were deemed illegible. Of the controlled drug prescriptions 11.1% (n = 167) met all the legal requirements. Therapeutic errors occurred in 41% of prescriptions (n = 479) More than 1 in 5 patients (21.9%) received a prescription containing a drug interaction. Part 2: 175 discrepancies were identified across all sources of medication information; of which 78 were deemed unintentional. Of these: 10.2% (n = 8) occurred at the point of admission, whereby 76.9% (n = 60) occurred at the point of discharge. The study identified the time of discharge as a point at which prescribing errors are likely to occur. This has implications for patient safety and provider work load in both primary and secondary care.

Oral antidiabetic therapy in a large Italian sample: drug supply and compliance for different therapeutic regimens

CERN Document Server

Vittorino Gaddi, A; Capello, F; Di Pietro, C; Cinconze, E; Rossi, E; De Sando, V; Cevenini, M; D'Alò, G

2014-01-01

Objectives: To define the main features of patients treated with oral antidiabetics, evaluating monotherapy (MT), loose-dose combination therapy (LDCT) and fixed-dose combination therapy (FDCT); to describe medication adherence to the different therapies; and to evaluate the differences in compliance with the prescribed therapy regimen among prevalent and incident patient cohorts. Study design: This study was a retrospective cohort analysis based on the ARNO database, a national record that tracks reimbursable prescription claims submitted from selected pharmacies to the Italian national health system. In total, 169,375 subjects, from an overall population of 4,040,624 were included in this study. The patients represented 12 different local health units. Each patient had at least one oral antidiabetic prescription claim (A10B ATC code). Methods: Patients were divided into four groups according to their treatment regimen during the recruitment period (1 January 2008-31 December 2008): MT, FDCT, LDCT and swi...

Opioid Prescriptions by Specialty in Ohio, 2010-2014.

Science.gov (United States)

Weiner, Scott G; Baker, Olesya; Rodgers, Ann F; Garner, Chad; Nelson, Lewis S; Kreiner, Peter W; Schuur, Jeremiah D

2018-05-01

The current US opioid epidemic is attributed to the large volume of prescribed opioids. This study analyzed the contribution of different medical specialties to overall opioids by evaluating the pill counts and morphine milligram equivalents (MMEs) of opioid prescriptions, stratified by provider specialty, and determined temporal trends. This was an analysis of the Ohio prescription drug monitoring program database, which captures scheduled medication prescriptions filled in the state as well as prescriber specialty. We extracted prescriptions for pill versions of opioids written in the calendar years 2010 to 2014. The main outcomes were the number of filled prescriptions, pill counts, MMEs, and extended-released opioids written by physicians in each specialty, and annual prescribing trends. There were 56,873,719 prescriptions for the studied opioids dispensed, for which 41,959,581 (73.8%) had prescriber specialty type available. Mean number of pills per prescription and MMEs were highest for physical medicine/rehabilitation (PM&R; 91.2 pills, 1,532 mg, N = 1,680,579), anesthesiology/pain (89.3 pills, 1,484 mg, N = 3,261,449), hematology/oncology (88.2 pills, 1,534 mg, N = 516,596), and neurology (84.4 pills, 1,230 mg, N = 573,389). Family medicine (21.8%) and internal medicine (17.6%) wrote the most opioid prescriptions overall. Time trends in the average number of pills and MMEs per prescription also varied depending on specialty. The numbers of pills and MMEs per opioid prescription vary markedly by prescriber specialty, as do trends in prescribing characteristics. Pill count and MME values define each specialty's contribution to overall opioid prescribing more accurately than the number of prescriptions alone.

Abuse of prescription drugs.

Science.gov (United States)

Wilford, B B

1990-01-01

An estimated 3% of the United States population deliberately misuse or abuse psychoactive medications, with severe consequences. According to the National Institute on Drug Abuse, more than half of patients who sought treatment or died of drug-related medical problems in 1989 were abusing prescription drugs. Physicians who contribute to this problem have been described by the American Medical Association as dishonest--willfully misprescribing for purposes of abuse, usually for profit; disabled by personal problems with drugs or alcohol; dated in their knowledge of current pharmacology or therapeutics; or deceived by various patient-initiated fraudulent approaches. Even physicians who do not meet any of these descriptions must guard against contributing to prescription drug abuse through injudicious prescribing, inadequate safeguarding of prescription forms or drug supplies, or acquiescing to the demands or ruses used to obtain drugs for other than medical purposes. PMID:2349801

Using 'big data' to validate claims made in the pharmaceutical approval process.

Science.gov (United States)

Wasser, Thomas; Haynes, Kevin; Barron, John; Cziraky, Mark

2015-01-01

Big Data in the healthcare setting refers to the storage, assimilation, and analysis of large quantities of information regarding patient care. These data can be collected and stored in a wide variety of ways including electronic medical records collected at the patient bedside, or through medical records that are coded and passed to insurance companies for reimbursement. When these data are processed it is possible to validate claims as a part of the regulatory review process regarding the anticipated performance of medications and devices. In order to analyze properly claims by manufacturers and others, there is a need to express claims in terms that are testable in a timeframe that is useful and meaningful to formulary committees. Claims for the comparative benefits and costs, including budget impact, of products and devices need to be expressed in measurable terms, ideally in the context of submission or validation protocols. Claims should be either consistent with accessible Big Data or able to support observational studies where Big Data identifies target populations. Protocols should identify, in disaggregated terms, key variables that would lead to direct or proxy validation. Once these variables are identified, Big Data can be used to query massive quantities of data in the validation process. Research can be passive or active in nature. Passive, where the data are collected retrospectively; active where the researcher is prospectively looking for indicators of co-morbid conditions, side-effects or adverse events, testing these indicators to determine if claims are within desired ranges set forth by the manufacturer. Additionally, Big Data can be used to assess the effectiveness of therapy through health insurance records. This, for example, could indicate that disease or co-morbid conditions cease to be treated. Understanding the basic strengths and weaknesses of Big Data in the claim validation process provides a glimpse of the value that this research

An Updated Analysis of Direct-to-Consumer Television Advertisements for Prescription Drugs.

Science.gov (United States)

Applequist, Janelle; Ball, Jennifer Gerard

2018-05-01

In 2015, the American Medical Association called for a ban of direct-to-consumer advertising (DTCA) for prescription drugs. Yet, the pharmaceutical industry spends more than ever on broadcast advertisements, with national health care costs largely driven by drug spending. An evaluation of these ads is critical, as these advertisements can impact the frequency which patients ask their doctors about medications. A content analysis of prime-time direct-to-consumer ads was conducted across 4 major cable television networks. The ad content (n = 61) was coded for factual claims made regarding target conditions, appeals used, portrayal of medications, and lifestyle characteristics shown. We found a substantial decrease in the percentage of ads that conveyed information about the conditions being targeted, such as risk factors (16%) and prevalence (16%). Positive emotional appeals (94%) continued to be emphasized; yet there was decreased use of negative emotional appeals (51%), pointing to an overall more positive portrayal of a patient's experience with a medication. The lifestyles portrayed in the sample largely featured how products can enable more recreational activities (69%) and fewer ads (7%) presented alternatives to product use. Direct-to-consumer advertising continued to promote prescription drugs above educating the population. Improvement in the educational value of DTCA is likely to require regulatory action rather than reliance on self-regulation by the pharmaceutical industry. © 2018 Annals of Family Medicine, Inc.

21 CFR 886.5844 - Prescription spectacle lens.

Science.gov (United States)

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Prescription spectacle lens. 886.5844 Section 886...) MEDICAL DEVICES OPHTHALMIC DEVICES Therapeutic Devices § 886.5844 Prescription spectacle lens. (a) Identification. A prescription spectacle lens is a glass or plastic device that is a lens intended to be worn by...

21 CFR 202.1 - Prescription-drug advertisements.

Science.gov (United States)

2010-04-01

... 21 Food and Drugs 4 2010-04-01 2010-04-01 false Prescription-drug advertisements. 202.1 Section 202.1 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS: GENERAL PRESCRIPTION DRUG ADVERTISING § 202.1 Prescription-drug advertisements. (e) * * * (6) * * * (ii) Represents or suggests that a...

Assessment of prescription sales in Ukraine

Directory of Open Access Journals (Sweden)

N. V. Teterich

2013-10-01

Full Text Available Currently, the state of the national health system (health is characterized by a low level of funding for medical and pharmaceutical care and the lack of effective methods of free and preferential dispensing of medicines (drugs and compensation of their value. Thus the most urgent problem arises is unregulated drugs prescription, which is one of the main negative factors behind the rapid spread of self-medication and polypragmasy. Thus, improving drugs prescription dispensing is one of the current challenges of medicine and pharmacy management which should be solved to provide a safe, rational and effective drug therapy. The results of the questionnaire survey of doctors and pharmaceutical workers identified and explored key factors that contribute to a violation of drugs prescription. The authors analyzed the literature on the current state of drugs prescription in Ukraine, which resulted in selected priority issues that need resolution as soon as possible. Established that the main disadvantages of the national health care system is unreasonable approach to state regulation of the relevant system and the low level of funding. This situation prevents rational regulation of free and preferential delivery of drugs, the introduction of obligatory medical insurance and the reimbursement cost of drugs and other modern approaches that are effective in developed countries. Тhe main motive of view of legislative acts to implement strict drugs prescription in Ukraine is a link to international experience, guided by the standards of European and international practices that do not comply with the Law of Ukraine issued on 18.03.2004 № 1629-IV «On the National Program for Adaptation of Ukraine to the European Union, "and points to the disparity modern domestic rule-making European practice. The fundamental problem here is the comparison of the legal, social, financial and economic status of the counter in Ukraine with the countries in which the system

Treatment patterns and health care resource utilization associated with dalfampridine extended release in multiple sclerosis: a retrospective claims database analysis

Directory of Open Access Journals (Sweden)

Guo A

2016-05-01

Full Text Available Amy Guo,1 Michael Grabner,2 Swetha Rao Palli,2 Jessica Elder,1 Matthew Sidovar,1 Peter Aupperle,1 Stephen Krieger3 1Acorda Therapeutics Inc., Ardsley, New York, NY, USA; 2HealthCore Inc., Wilmington, DE, USA; 3Corinne Goldsmith Dickinson Center for MS, Icahn School of Medicine at Mount Sinai, New York, NY, USA Background: Although previous studies have demonstrated the clinical benefits of dalfampridine extended release (D-ER tablets in patients with multiple sclerosis (MS, there are limited real-world data on D-ER utilization and associated outcomes in patients with MS. Purpose: The objective of this study was to evaluate treatment patterns, budget impact, and health care resource utilization (HRU associated with D-ER use in a real-world setting. Methods: A retrospective claims database analysis was conducted using the HealthCore Integrated Research DatabaseSM. Adherence (measured by medication possession ratio, or [MPR] and persistence (measured by days between initial D-ER claim and discontinuation or end of follow-up were evaluated over 1-year follow-up. Budget impact was calculated as cost per member per month (PMPM over the available follow-up period. D-ER and control cohorts were propensity-score matched on baseline demographics, comorbidities, and MS-related resource utilization to compare walking-impairment-related HRU over follow-up. Results: Of the 2,138 MS patients identified, 1,200 were not treated with D-ER (control and 938 were treated with D-ER. Patients were aged 51 years on average and 74% female. Approximately 82.6% of D-ER patients were adherent (MPR >80%. The estimated budget impact range of D-ER was $0.014–$0.026 PMPM. Propensity-score-matched D-ER and controls yielded 479 patients in each cohort. Postmatching comparison showed that the D-ER cohort was associated with fewer physician (21.5% vs 62.4%, P<0.0001 and other outpatient visits (22.8% vs 51.4%, P<0.0001 over the 12-month follow-up. Changes in HRU from follow

Association of intradialytic hypotension and convective volume in hemodiafiltration: results from a retrospective cohort study

Directory of Open Access Journals (Sweden)

Mora-Bravo Franklin G

2012-09-01

Full Text Available Abstract Background Hemodiafiltration (HDF, as a convective blood purification technique, has been associated with favorable outcomes improved phosphate control, removal of middle-molecules such as Beta2-microglobulin and the occurrence of intradialytic hypotension (IDH as compared to diffusive techniques. The aim of this retrospective cohort study in dialysis patients receiving HDF in one urban dialysis facility in Mexico City was to investigate the occurrence of IDH during HDF treatments with varying convective volume prescriptions. Methods Subjects were stratified into equal groups of percentiles of convective volume prescription: Group 1 of 0 to 7.53 liters, group 2 of 7.54 to 14.8 liters, group 3 of 14.9 to 16.96 liters, group 4 of 16.97 to 18.9 liters, group 5 of 21 to 19.9 liters and group 6 of 21.1 to 30 liters. Logistic Regression with and without adjustment for confounding factors was used to evaluate factors associated with the occurrence of IDH. Results 2276 treatments of 154 patients were analyzed. IDH occurred during 239 HDF treatments (10.5% of all treatments. Group 1 showed 31 treatments (8.2% with IDH whereas group 6 showed IDH in only 15 sessions (4% of all treatments. Odds Ratio of IDH for Group 6 was 0.47 (95% CI 0.25 to 0.88 as compared to Group 1 after adjustment. Conclusions In summary the data of this retrospective cohort study shows an inverse correlation between the occurrence of IDH and convective volume prescription. Further research in prospective settings is needed to confirm these findings.

The Decline in Hydrocodone/Acetaminophen Prescriptions in Emergency Departments in the Veterans Health Administration Between 2009 to 2015

Directory of Open Access Journals (Sweden)

Michael A. Grasso

2016-06-01

Full Text Available Introduction: The purpose of the study was to measure national prescribing patterns for hydrocodone/acetaminophen among veterans seeking emergency medical care, and to see if patterns have changed since this medication became a Schedule II controlled substance. Methods: We conducted a retrospective cohort study of emergency department (ED visits within the Veterans Health Administration (VA between January 2009 and June 2015. We looked at demographics, comorbidities, utilization measures, diagnoses, and prescriptions. Results: During the study period, 1,709,545 individuals participated in 6,270,742 ED visits and received 471,221 prescriptions for hydrocodone/acetaminophen (7.5% of all visits. The most common diagnosis associated with a prescription was back pain. Prescriptions peaked at 80,776 in 2011 (8.7% of visits, and declined to 35,031 (5.6% during the first half of 2015 (r=‒0.99, p<0.001. The percentage of hydrocodone/acetaminophen prescriptions limited to 12 pills increased from 22% (13,949 in 2009 to 31% (11,026 in the first half of 2015. A prescription was more likely written for patients with a pain score≥7 (OR 3.199, CI [3.192‒3.205], a musculoskeletal (OR 1.622, CI [1.615‒1.630] or soft tissue (OR 1.656, CI [1.649‒1.664] diagnosis, and those below the first quartile for total ED visits (OR 1.282, CI [1.271‒1.293] and total outpatient ICD 9 codes (OR 1.843, CI [1.833‒1.853]. Conclusion: Hydrocodone/acetaminophen is the most frequently prescribed ED medication in the VA. The rate of prescribing has decreased since 2011, with the rate of decline remaining unchanged after it was classified as a Schedule II controlled substance. The proportion of prescriptions falling within designated guidelines has increased but is not at goal. [West J Emerg Med. 2016;17(4:396-403.

Drug prescriptions in Danish out-of-hours primary care

DEFF Research Database (Denmark)

Christensen, Morten Bondo; Nørøxe, Karen Busk; Moth, Grete

2016-01-01

of prescriptions per 100 contacts. RESULTS: Of 644,777 contacts, 154,668 (24.0%) involved medication prescriptions; 21.9% of telephone consultations, 32.9% of clinic consultations and 14.3% of home visits. Around 53% of all drug prescriptions were made in telephone consultations. Anti-infective medications...... for systemic use accounted for 45.5% of all prescriptions and were the most frequently prescribed drug group for all contact types, although accounting for less than 1/3 of telephone prescriptions. Other frequently prescribed drugs were ophthalmological anti-infectives (10.5%), NSAIDs (6.4%), opioids (3......) primary care services cover more than 75% of all hours during a normal week, insight into the extent and type of OOH drug prescription is important. General practitioners (GPs) are responsible for more than 80% of all drug prescriptions in Denmark. Of all contacts 24.0% involved medication prescriptions...

Prescription Stimulants Are "A Okay": Applying Neutralization Theory to College Students' Nonmedical Prescription Stimulant Use

Science.gov (United States)

Cutler, Kristin A.

2014-01-01

Objective: National college health data indicate that prescription stimulants are the most widely misused prescription drugs among college students, with 9% admitting to nonmedical use within the past year. Although motivations for the nonmedical use of these drugs have been explored, scant attention has been paid to justifications for nonmedical…

The Optimizing Strategies for Prescription of Sleeping Pills for Insomnia Patients

Directory of Open Access Journals (Sweden)

Seockhoon Chung

2017-06-01

Full Text Available Many patients claim that they cannot sleep well despite ingestion of sleeping pills. In such cases, the physician should explore the reason why sleep disturbance persisted in patients despite administration of sleeping pills. We should consider patients’ age, gender, medical or psychiatric diseases, workplace, or sleep environment that may influence patients’ sleep and satisfaction with their hypnotics. However, prior to prescribing a hypnotic agent for patients with sleep disturbance, good sleep hygiene education should be provided first. Cognitive-behavioral therapy for insomnia is an important and effective treatment modality to improve patients’ sleep quality and reduce dosage of sleeping pills, but it is not easy for most general practitioners to learn and practice this modality. Therefore, we need to consider how to optimize the prescription of hypnotics for treating insomnia in order to prescribe hypnotics safely and appropriately at the lowest dosage. Physician should consider the mechanism of action of each hypnotic agent and prescribe proper hypnotics according to patients’ comorbid illness, insomnia types, or other underlying sleep disorders. Also, we should instruct the patients about when they should take their sleeping pills and we should monitor whether they have followed the instructions or not. Hospitalized patients are in a different sleep environment compared to outpatients, and therefore, we should also prepare modified management strategies for inpatients. In this review, strategies for optimizing the prescription of sleeping pills for insomnia patients will be discussed.

A Prescription Survey from Sri Lanka

African Journals Online (AJOL)

adherence to standard guidelines on the layout and content of prescriptions. Method: A ... Conclusion: Prescription errors are common in outpatient settings of Aluthgama and Kandy areas in .... qualification of the prescriber was present, it was.

Direct-to-Consumer Promotion of Prescription Drugs on Mobile Devices: Content Analysis.

Science.gov (United States)

Aikin, Kathryn J; Sullivan, Helen W; Dolina, Suzanne; Lynch, Molly; Squiers, Linda B

2017-07-04

US Food and Drug Administration (FDA) regulations state that any prescription drug promotion that presents drug benefits to consumers must also disclose certain information about the drug's risks in a similar manner. Nearly three-quarters of all US mobile phone subscribers use a smartphone, and over half report receiving mobile advertisements on their device. The objective of this project was to investigate how prescription drugs are being promoted to consumers using mobile technologies. We were particularly interested in the presentation of drug benefits and risks, with regard to presence, placement, and prominence. We analyzed a sample of 51 mobile promotional communications and their associated linked landing pages. We assessed the content and format of the mobile communications and landing pages with regard to presentation of drug benefits and risks. Of the 51 mobile communications we coded, 41% (21/51) were product claim communications (includes the drug name, benefits, and risks), 22% (11/51) were reminder communications (includes drug name only), and 37% (19/51) were help-seeking communications (includes information about the medical condition but not the drug name). Some of the product claim communications (5/21, 24%) required scrolling to see all the benefit information; in contrast, 95% (20/21) required scrolling to see all the risk information. Of the 19 product claim communications that presented both benefits and risks, 95% (18/19) presented benefits before risks and 47% (9/19) used a bigger font for benefits than for risks. Most mobile communications (35/51, 69%) linked to branded drug websites with both benefits and risks, 25% (13/51) linked to a landing page with benefits but no visible risks, and 6% (3/51) linked to a landing page with risks but no visible benefits. Few landing pages (4/51, 8%) required scrolling to see all the benefit information; in contrast, 51% (26/51) required scrolling to see all the risk information. Of the 35 landing pages

A 12-year analysis of closed medical malpractice claims of the Taiwan civil court

Science.gov (United States)

Hwang, Chi-Yuan; Wu, Chien-Hung; Cheng, Fu-Cheng; Yen, Yung-Lin; Wu, Kuan-Han

2018-01-01

Abstract Malpractices lawsuits cause increased physician stress and decreased career satisfaction, which might result in defensive medicine for avoiding litigation. It is, consequently, important to learn experiences from previous malpractice claims. The aim of this study was to examine the epidemiologic factors related to medical malpractice claims, identify specialties at high risk of such claims, and determine clinical which errors tend to lead to medical malpractice lawsuits, by analyzing closed malpractice claims in the civil courts of Taiwan. The current analysis reviewed the verdicts of the Taiwan judicial system from a retrospective study using the population-based databank, focusing on 946 closed medical claims between 2002 and 2013. Among these medical malpractice claims, only 14.1% of the verdicts were against clinicians, with a mean indemnity payment of $83,350. The most common single specialty involved was obstetrics (10.7%), while the surgery group accounted for approximately 40% of the cases. In total, 46.3% of the patients named in the claims had either died or been gravely injured. Compared to the $75,632 indemnity for deceased patients, the mean indemnity payment for plaintiffs with grave outcomes was approximately 4.5 times higher. The diagnosis groups at high risk of malpractice litigation were infectious diseases (7.3%), malignancies (7.2%), and limb fractures (4.9%). A relatively low success rate was found in claims concerning undiagnosed congenital anomalies (4.5%) and infectious diseases (5.8%) group. A surgery dispute was the most frequent argument in civil malpractice claims (38.8%), followed by diagnosis error (19.3%). Clinicians represent 85.9% of the defendants who won their cases, but they spent an average of 4.7 years to reach final adjudication. Increased public education to prevent unrealistic expectations among patients is recommended to decrease frivolous lawsuits. Further investigation to improve the lengthy judicial process is

Increasing access to emergency contraception through online prescription requests.

Science.gov (United States)

Averbach, Sarah; Wendt, Jacqueline Moro; Levine, Deborah K; Philip, Susan S; Klausner, Jeffrey D

2010-01-01

To describe a pilot program, Plan B Online Prescription Access, to provide easy access to prescriptions for emergency contraception via the Internet. We measured electronic prescriptions for Plan B (Duramed Pharmaceuticals, Cincinnati, Ohio) by month over time. Pharmacists faxed patient-generated prescriptions back to the Department of Public Health for confirmation. Despite no marketing, within the first 18 months of the program, 152 electronic prescriptions for Plan B were requested by 128 female San Francisco residents. Seventy-eight prescriptions were filled (51%) by pharmacists. If correctly marketed, online prescriptions for Plan B have the potential to be an effective means of increasing emergency contraception access in both urban and rural settings across the United States. Further user-acceptability studies are warranted.

Evaluation of US prescription patterns: Are treatment guidelines for cancer-associated venous thromboembolism being followed?

Science.gov (United States)

Khorana, Alok A; Yannicelli, Daniel; McCrae, Keith R; Milentijevic, Dejan; Crivera, Concetta; Nelson, Winnie W; Schein, Jeffrey R

2016-09-01

Venous thromboembolism (VTE) is a common complication of cancer. Clinical practice guidelines recommend low-molecular-weight heparin (LMWH) for treatment of cancer-associated VTE, but it is unclear how frequently these are followed. This study assessed anticoagulation treatment patterns for VTE in newly diagnosed cancer patients in the United States. MarketScan® claims records of more than 80 million insured members between January 1, 2009 and July 31, 2014 were retrospectively analyzed. Subjects were included if they were 18years of age or older, and had a diagnosis of cancer (9 solid tumor types) and VTE. Data were included for LMWH, warfarin, and other anticoagulants (fondaparinux and direct oral anticoagulants [DOACs]). Patients with anticoagulant treatment prior to cancer diagnosis were excluded. VTE developed in 6.2% of cancer patients (median, 181days after cancer diagnosis). VTE rates were highest for pancreatic (17.5%) and lung (12.6%) cancer and lowest for breast (4.2%) and prostate (4.1%) cancer. For patients for whom outpatient prescription data were available, warfarin was most commonly used (50.0%), followed by LMWH (40.0%) and other anticoagulants (10.0%). Over 6months, 13% of patients who initiated injectable anticoagulants remained on them compared with 30% of those who initiated oral anticoagulants. More patients switched from LMWH to warfarin and other anticoagulants (44%) versus those who switched from warfarin (28%). Warfarin was the most utilized anticoagulant for cancer-associated VTE despite guideline recommendations for LMWH. More patients remained on oral versus injectable agents, which may be related to self-injection burden and costs. Copyright © 2016 Elsevier Ltd. All rights reserved.

Asthma Controller Medications for Children in Japan

Directory of Open Access Journals (Sweden)

Shota Hamada DrPH

2015-04-01

Full Text Available Background. Treatment and management strategies for asthma in children are generally consistent internationally, but prescription of antiasthma drugs differs among countries. The objective of this study was to examine the prescribing patterns of antiasthma drugs, particularly controller medications, in children. Methods. A retrospective cohort study was performed in children with asthma using an administrative claims database in Japan. Results. A total of 1149 preschool-age and 3226 school-age children were identified. Leukotriene receptor antagonists were prescribed for about 80% of the children. Long-acting β-agonists were prescribed for 87.6% and 59.6% of preschool-age and school-age children, respectively, whereas prescriptions of inhaled corticosteroids had lower rates of 8.2% and 16.5%, respectively. In an examination of prescriptions at 1-month intervals, a relatively high number of children were prescribed bronchodilators without anti-inflammatory agents. Conclusion. Our findings suggest that asthma care for children in Japan can be improved through changes in drug prescriptions.

Should the District Courts Have Jurisdiction Over Pre-Award Contract Claims? A Claim for the Claims Court

National Research Council Canada - National Science Library

Short, John J

1987-01-01

This thesis briefly examines the jurisdiction of the federal district courts and the United States Court of Claims over pre-award contract claims before the Federal Courts Improvement Act of October 1...

A smart-card-enabled privacy preserving E-prescription system.

Science.gov (United States)

Yang, Yanjiang; Han, Xiaoxi; Bao, Feng; Deng, Robert H

2004-03-01

Within the overall context of protection of health care information, privacy of prescription data needs special treatment. First, the involvement of diverse parties, especially nonmedical parties in the process of drug prescription complicates the protection of prescription data. Second, both patients and doctors have privacy stakes in prescription, and their privacy should be equally protected. Third, the following facts determine that prescription should not be processed in a truly anonymous manner: certain involved parties conduct useful research on the basis of aggregation of prescription data that are linkable with respect to either the patients or the doctors; prescription data has to be identifiable in some extreme circumstances, e.g., under the court order for inspection and assign liability. In this paper, we propose an e-prescription system to address issues pertaining to the privacy protection in the process of drug prescription. In our system, patients' smart cards play an important role. For one thing, the smart cards are implemented to be portable repositories carrying up-to-date personal medical records and insurance information, providing doctors instant data access crucial to the process of diagnosis and prescription. For the other, with the secret signing key being stored inside, the smart card enables the patient to sign electronically the prescription pad, declaring his acceptance of the prescription. To make the system more realistic, we identify the needs for a patient to delegate his signing capability to other people so as to protect the privacy of information housed on his card. A strong proxy signature scheme achieving technologically mutual agreements on the delegation is proposed to implement the delegation functionality.

Prosthesis Prescription Protocol of the Arm (PPP-Arm) : The implementation of a national prosthesis prescription protocol

NARCIS (Netherlands)

Wijdenes, Paula; Brouwers, Michael; van der Sluis, Corry K

BACKGROUND AND AIM: In order to create more uniformity in the prescription of upper limb prostheses by Dutch rehabilitation teams, the development and implementation of a Prosthesis Prescription Protocol of the upper limb (PPP-Arm) was initiated. The aim was to create a national digital protocol to

An inevitable wave of prescription drug monitoring programs in the context of prescription opioids: pros, cons and tensions

OpenAIRE

Islam, M Mofizul; McRae, Ian S

2014-01-01

Background In an effort to control non-medical use and/or medical abuse of prescription drugs, particularly prescription opioids, electronic prescription drug monitoring programs (PDMP) have been introduced in North-American countries, Australia and some parts of Europe. Paradoxically, there are simultaneous pressures to increase opioid prescribing for the benefit of individual patients and to reduce it for the sake of public health, and this pressure warrants a delicate balance of appropriat...

Prescriptions of traditional Chinese medicine, western medicine, and integrated Chinese-Western medicine for allergic rhinitis under the National Health Insurance in Taiwan.

Science.gov (United States)

Huang, Sheng-Kang; Ho, Yu-Ling; Chang, Yuan-Shiun

2015-09-15

Allergic rhinitis has long been a worldwide health problem with a global growth trend. The use of traditional Chinese medicines alone or integrated Chinese-Western medicines for its treatment is quite common in Taiwan. Respiratory diseases account for the majority of outpatient traditional Chinese medicine treatment, while allergic rhinitis accounts for the majority of respiratory diseases. We hereby conduct a comparative analysis between traditional Chinese medicine treatments and western medicine treatments for allergic rhinitis in Taiwan. The results of the analysis on the prescription difference of traditional Chinese medicine and western medicine treatments would be helpful to clinical guide and health policy decision making of ethnopharmacological therapy. Patients diagnosed as allergic rhinitis with diagnostic code 470-478 (ICD-9-CM) were selected as subjects from 2009-2010 National Health Insurance Research Database based on the claim data from the nationwide National Health Insurance in Taiwan. This retrospective study used Chi-Square test to test the effects of gender and age on visit of traditional Chinese medicine, western medicine, and integrated Chinese-Western medicine treatments. A total of 45,804 patients diagnosed as allergic rhinitis with ICD-9-CM 470-478 were identified from 2009-2010 NHIRD. There were 36,874 subjects for western medicine treatment alone, 5829 subjects for traditional Chinese medicine treatment alone, and 3101 subjects for integrated Chinese-Western medicine treatment. Female patients were more than male in three treatments. 0-9 years children had the highest visit frequency in western medicine and integrated Chinese-Western medicine groups, while 10-19 years young-age rank the highest in traditional Chinese medicine group. The Chi-square test of independence showed that the effects of gender and age on visit of three treatments were significant. The prescription drugs of western medicine treatment alone were almost for

The use of psychoactive prescription drugs among DUI suspects.

Science.gov (United States)

Karjalainen, Karoliina; Haukka, Jari; Lintonen, Tomi; Joukamaa, Matti; Lillsunde, Pirjo

2015-10-01

The study seeks to increase understanding of the use of psychoactive prescription drugs among persons suspected of driving under the influence (DUI). We studied whether the use of prescribed psychoactive medication was associated with DUI, and examined the difference in the use of prescription drugs between DUI recidivists and those arrested only once. In this register-based study, persons suspected of DUI (n=29470) were drawn from the Register of DUI suspects, and an age- and gender-matched reference population (n=30043) was drawn from the Finnish general population. Data on prescription drug use was obtained by linkage to the National Prescription Register. The associations of DUI arrest and use of psychoactive prescription drugs in different DUI groups (findings for alcohol only, prescription drugs, prescription drugs and alcohol, illicit drugs) were estimated by using mixed-effect logistic regression. The use of psychoactive prescription drugs and DUI appeared to be strongly associated, with DUI suspects significantly more likely to use psychoactive prescription drugs compared to the reference population. Gender differences existed, with the use of benzodiazepines being more common among female DUI suspects. Moreover, DUI recidivists were more likely to use psychoactive prescription drugs compared to those arrested only once. In addition to alcohol and/or illicit drug use, a significant proportion of DUI suspects were using psychoactive prescription drugs. When prescribing psychoactive medication, especially benzodiazepines, physicians are challenged to screen for possible substance use problems and also to monitor for patients' alcohol or illicit drug use while being medicated. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Influence of pharmacists expertise on physicians prescription ...

African Journals Online (AJOL)

the prescribing behaviour of physicians. ... Keywords: Physician prescription behaviour, Pharmacist factor, Collaboration, Trustworthiness ... provide information relating to drug prescription, ... processing [22], which takes into consideration.

Prescription-induced jump distributions in multiplicative Poisson processes.

Science.gov (United States)

Suweis, Samir; Porporato, Amilcare; Rinaldo, Andrea; Maritan, Amos

2011-06-01

Generalized Langevin equations (GLE) with multiplicative white Poisson noise pose the usual prescription dilemma leading to different evolution equations (master equations) for the probability distribution. Contrary to the case of multiplicative Gaussian white noise, the Stratonovich prescription does not correspond to the well-known midpoint (or any other intermediate) prescription. By introducing an inertial term in the GLE, we show that the Itô and Stratonovich prescriptions naturally arise depending on two time scales, one induced by the inertial term and the other determined by the jump event. We also show that, when the multiplicative noise is linear in the random variable, one prescription can be made equivalent to the other by a suitable transformation in the jump probability distribution. We apply these results to a recently proposed stochastic model describing the dynamics of primary soil salinization, in which the salt mass balance within the soil root zone requires the analysis of different prescriptions arising from the resulting stochastic differential equation forced by multiplicative white Poisson noise, the features of which are tailored to the characters of the daily precipitation. A method is finally suggested to infer the most appropriate prescription from the data.

Prescription-induced jump distributions in multiplicative Poisson processes

Science.gov (United States)

Suweis, Samir; Porporato, Amilcare; Rinaldo, Andrea; Maritan, Amos

2011-06-01

Generalized Langevin equations (GLE) with multiplicative white Poisson noise pose the usual prescription dilemma leading to different evolution equations (master equations) for the probability distribution. Contrary to the case of multiplicative Gaussian white noise, the Stratonovich prescription does not correspond to the well-known midpoint (or any other intermediate) prescription. By introducing an inertial term in the GLE, we show that the Itô and Stratonovich prescriptions naturally arise depending on two time scales, one induced by the inertial term and the other determined by the jump event. We also show that, when the multiplicative noise is linear in the random variable, one prescription can be made equivalent to the other by a suitable transformation in the jump probability distribution. We apply these results to a recently proposed stochastic model describing the dynamics of primary soil salinization, in which the salt mass balance within the soil root zone requires the analysis of different prescriptions arising from the resulting stochastic differential equation forced by multiplicative white Poisson noise, the features of which are tailored to the characters of the daily precipitation. A method is finally suggested to infer the most appropriate prescription from the data.

Past-year Prescription Drug Monitoring Program Opioid Prescriptions and Self-reported Opioid Use in an Emergency Department Population With Opioid Use Disorder.

Science.gov (United States)

Hawk, Kathryn; D'Onofrio, Gail; Fiellin, David A; Chawarski, Marek C; O'Connor, Patrick G; Owens, Patricia H; Pantalon, Michael V; Bernstein, Steven L

2017-11-22

Despite increasing reliance on prescription drug monitoring programs (PDMPs) as a response to the opioid epidemic, the relationship between aberrant drug-related behaviors captured by the PDMP and opioid use disorder is incompletely understood. How PDMP data should guide emergency department (ED) assessment has not been studied. The objective was to evaluate a relationship between PDMP opioid prescription records and self-reported nonmedical opioid use of prescription opioids in a cohort of opioid-dependent ED patients enrolled in a treatment trial. PDMP opioid prescription records during 1 year prior to study enrollment on 329 adults meeting Diagnostic and Statistical Manual IV criteria for opioid dependence entering a randomized clinical trial in a large, urban ED were cross-tabulated with data on 30-day nonmedical prescription opioid use self-report. The association among these two types of data was assessed by the Goodman and Kruskal's gamma; a logistic regression was used to explore characteristics of participants who had PDMP record of opioid prescriptions. During 1 year prior to study enrollment, 118 of 329 (36%) patients had at least one opioid prescription (range = 1-51) in our states' PDMP. Patients who reported ≥15 of 30 days of nonmedical prescription opioid use were more likely to have at least four PDMP opioid prescriptions (20/38; 53%) than patients reporting 1 to 14 days (14/38, 37%) or zero days of nonmedical prescription opioid use (4/38, 11%; p = 0.002). Female sex and having health insurance were significantly more represented in the PDMP (p Medicine.

Prescription frequency and patterns of Chinese herbal medicine for liver cancer patients in Taiwan: a cross-sectional analysis of the National Health Insurance Research Database.

Science.gov (United States)

Ting, Chin-Tsung; Kuo, Chian-Jue; Hu, Hsiao-Yun; Lee, Ya-Ling; Tsai, Tung-Hu

2017-02-20

Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related deaths worldwide. Chinese herbal medicine (CHM) is frequently provided to HCC patients. The aim of this study was to understand the prescription frequency and patterns of CHM for HCC patients by analyzing the claims data from the National Health Insurance (NHI) in Taiwan. We identified 73918 newly diagnosed HCC subjects from the database of Registry for Catastrophic Illness during 2002 to 2009 and to analyze the frequency and pattern of corresponding CHM prescriptions for HCC patients. There were a total of 685,079 single Chinese herbal prescriptions and 553,952 Chinese herbal formula prescriptions used for 17,373 HCC subjects before 2 years of HCC diagnosis. Among the 13,093 HCC subjects who used CHMs after HCC diagnosis, there were 462,786 single Chinese herbal prescriptions and 300,153 Chinese herbal formula prescriptions were counted. By adjusting with person-year and ratio of standardized incidence rate, the top ten prescribed single herbal drugs and Chinese herbal formulas for HCC patients were described in our study. Among them, we concluded that, Oldenlandia diffusa (Chinese herbal name: Bai-Hua-She-She-Cao), Radix et Rhizoma Rhei (Da Huang) and the herbal preparation of Xiao-Chai-Hu-Tang and Gan-Lu-Yin, were the most obviously increased and important CHMs been used for HCC patients. We established an accurate and validated method for the actual frequency and patterns of CHM use in treating HCC in Taiwan. We propose that these breakthrough findings may have important implications for HCC therapy, clinical trials and modernization of CHM.

The Effect of a Statewide Mandatory Prescription Drug Monitoring Program on Opioid Prescribing by Emergency Medicine Providers Across 15 Hospitals in a Single Health System.

Science.gov (United States)

Suffoletto, Brian; Lynch, Michael; Pacella, Charissa B; Yealy, Donald M; Callaway, Clifton W

2018-04-01

Prescription drug monitoring programs (PDMPs) enable registered prescribers to obtain real-time information on patients' prescription history of controlled medications. We sought to describe the effect of a state-mandated PDMP on opioid prescribing by emergency medicine providers. We retrospectively analyzed electronic medical records of 122,732 adult patients discharged with an opioid prescription from 15 emergency departments in a single health system in Pennsylvania from July 2015 to March, 2017. We used an interrupted time series design to evaluate the percentage of patients discharged each month with an opioid prescription before and after state law-mandated PDMP use on August 25, 2016. From August (pre-PDMP) to September, 2016 (post-PDMP), the opioid prescribing rate decreased from 12.4% (95% confidence interval [CI], 10.8%-14.1%) to 10.2% (95% CI, 8.8%-11.8%). For each month between September 2016 to March 2017, there was a mean decline of .46% (95% CI, -.38% to -.53%) in the percentage of patients discharged with an opioid prescription. There was heterogeneity in opioid prescribing across hospitals as well as according to patient diagnosis. This study examined the effect of a state-mandated PDMP on opioid prescribing among emergency medicine providers from 15 different hospitals in a single health system. Findings support current PDMP mandates in reducing opioid prescriptions, which could curb the prescription opioid epidemic and may ultimately reduce abuse, misuse, and overdose death. Copyright © 2017 The American Pain Society. Published by Elsevier Inc. All rights reserved.

Framing and Claiming: How Information-Framing Affects Expected Social Security Claiming Behavior.

Science.gov (United States)

Brown, Jeffrey R; Kapteyn, Arie; Mitchell, Olivia S

2016-03-01

This paper provides evidence that Social Security benefit claiming decisions are strongly affected by framing and are thus inconsistent with expected utility theory. Using a randomized experiment that controls for both observable and unobservable differences across individuals, we find that the use of a "breakeven analysis" encourages early claiming. Respondents are more likely to delay when later claiming is framed as a gain, and the claiming age is anchored at older ages. Additionally, the financially less literate, individuals with credit card debt, and those with lower earnings are more influenced by framing than others.

SyncClaimService

Data.gov (United States)

Department of Veterans Affairs — Provides various methods to sync Claim related data for NWQ processing. It includes web operations to get Claims, get Unique Contention Classifications, get Unique...

The Effects of Bairesi Complex Prescription (a Uyghur Medicine Prescription and Its Five Crude Herbal Extracts on Melanogenesis in G-361 Cells

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Xuedan Huang

2016-01-01

Full Text Available Vitiligo is considered a preimmune stage of a disease that is not well clarified. This condition is difficult to treat because there is no definite cure. Uyghur medicine is an important part of traditional Chinese medicine. There are many types of prescriptions that are used for the treatment of vitiligo. Bairesi complex prescription is one of the active prescriptions for vitiligo that is used in the clinic. However, the intensities of melanogenesis due to uses of Bairesi complex prescription and its five constituent crude herbs have not been reported yet. In the present study, we found that the hot water extracts of Bairesi complex prescription and the crude herbs were more effective in eliciting melanin production in G-361 cells than the EtOH extracts. Furthermore, the Bairesi complex prescription exhibited less cytotoxicity and was more effective in melanin formation than the five crude herbal extracts. In the present study, we also discuss the mechanisms of melanogenesis due to the use of the Bairesi complex prescription and its single crude herbal extracts.

Description, prescription and the choice of discount rates

International Nuclear Information System (INIS)

Baum, Seth D.

2009-01-01

The choice of discount rates is a key issue in the analysis of long-term societal issues, in particular environmental issues such as climate change. Approaches to choosing discount rates are generally placed into two categories: the descriptive approach and the prescriptive approach. The descriptive approach is often justified on grounds that it uses a description of how society discounts instead of having analysts impose their own discounting views on society. This paper analyzes the common forms of the descriptive and prescriptive approaches and finds that, in contrast with customary thinking, both forms are equally descriptive and prescriptive. The prescriptions concern who has standing (i.e. who is included) in society, how the views of these individuals are measured, and how the measurements are aggregated. Such prescriptions are necessary to choose from among the many possible descriptions of how society discounts. The descriptions are the measurements made given a choice of measurement technique. Thus, the labels 'descriptive approach' and 'prescriptive approach' are deeply misleading, as analysts cannot avoid imposing their own views on society. (author)

Framing and Claiming: How Information-Framing Affects Expected Social Security Claiming Behavior

Science.gov (United States)

Brown, Jeffrey R.; Kapteyn, Arie; Mitchell, Olivia S.

2017-01-01

This paper provides evidence that Social Security benefit claiming decisions are strongly affected by framing and are thus inconsistent with expected utility theory. Using a randomized experiment that controls for both observable and unobservable differences across individuals, we find that the use of a “breakeven analysis” encourages early claiming. Respondents are more likely to delay when later claiming is framed as a gain, and the claiming age is anchored at older ages. Additionally, the financially less literate, individuals with credit card debt, and those with lower earnings are more influenced by framing than others. PMID:28579641

Association between unemployment rates and prescription drug utilization in the United States, 2007–2010

Science.gov (United States)

2012-01-01

Background While extensive evidence suggests that the economic recession has had far reaching effects on many economic sectors, little is known regarding its impact on prescription drug utilization. The purpose of this study is to describe the association between state-level unemployment rates and retail sales of seven therapeutic classes (statins, antidepressants, antipsychotics, angiotensin-converting enzyme [ACE] inhibitors, opiates, phosphodiesterase [PDE] inhibitors and oral contraceptives) in the United States. Methods Using a retrospective mixed ecological design, we examined retail prescription sales using IMS Health Xponent™ from September 2007 through July 2010, and we used the Bureau of Labor Statistics to derive population-based rates and mixed-effects modeling with state-level controls to examine the association between unemployment and utilization. Our main outcome measure was state-level utilization per 100,000 people for each class. Results Monthly unemployment levels and rates of use of each class varied substantially across the states. There were no statistically significant associations between use of ACE inhibitors or SSRIs/SNRIs and average unemployment in analyses across states, while for opioids and PDE inhibitors there were small statistically significant direct associations, and for the remaining classes inverse associations. Analyses using each state as its own control collectively exhibited statistically significant positive associations between increases in unemployment and prescription drug utilization for five of seven areas examined. This relationship was greatest for statins (on average, a 4% increase in utilization per 1% increased unemployment) and PDE inhibitors (3% increase in utilization per 1% increased unemployment), and lower for oral contraceptives and atypical antipsychotics. Conclusion We found no evidence of an association between increasing unemployment and decreasing prescription utilization, suggesting that any

Audit of carbapenem prescriptions comparing 2 assessment periods.

Science.gov (United States)

Lefébure, A; Papy, E; Rioux, C; Diamantis, S; Armand-Lefèvre, L; Longuet, P; Lescure, F X; Wolff, M; Arnaud, P; Lucet, J C

2015-07-01

The emergence of extended-spectrum beta-lactamase (ESBL) producing Enterobacteriaceae has resulted in the increase of carbapenem prescriptions. The objective of our study was to determine the appropriateness of carbapenem prescriptions from initiation to reassessment of treatment, between 2009 and 2011. A questionnaire drafted by infectious diseases specialists (IDS) and microbiologists was used to collect clinical and microbiological data concerning carbapenem prescriptions in 2009 and 2011. An IDS then compared the results to assess carbapenem prescription compliance with our hospital's local recommendations. Seventy-one prescriptions were included in 2009 and 32 in 2011. The carbapenem treatment had been most frequently probabilistic to treat nosocomial infections. The microbiological data revealed that the number of multidrug-resistant (MDR) infections had increased between 2009 and 2011, especially infections involving ESBL-producing Enterobacteriaceae. At treatment reassessment, in 2009 and 2011, 15 (21%) and 12 (38%) carbapenem prescriptions were appropriate and continued. Overall, when comparing the 2 periods, prescriptions complied with local guidelines from initiation to reassessment of treatment without any statistically significant difference (68% in 2009 and 75% in 2011). Our study results showed that MDR infections had increased and especially infections due to ESBL-producing Enterobacteriaceae; this was consistent with epidemiological data. We also proved that most carbapenem prescriptions were compliant with recommendations. The increased mobile IDS interventions in medical and surgical departments helped reach this rate of compliance. Carbapenem stewardship may be promoted even in a difficult epidemiological context, especially with IDS interventions for the duration of treatment or at treatment reassessment. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Subtypes of nonmedical prescription drug misuse

Science.gov (United States)

McCabe, Sean Esteban; Boyd, Carol J.; Teter, Christian J.

2010-01-01

This study used three characteristics (i.e., motive, route of administration, and co-ingestion with alcohol) of nonmedical prescription drug misuse across four separate classes (i.e., pain, sedative/anxiety, sleeping and stimulant medications) to examine subtypes and drug related problems. A Web survey was self-administered by a randomly selected sample of 3,639 undergraduate students attending a large Midwestern 4-year U.S. university. Self-treatment subtypes were characterized by motives consistent with the prescription drug's pharmaceutical main indication, oral only routes of administration, and no co-ingestion with alcohol. Recreational subtypes were characterized by recreational motives, oral or non-oral routes, and co-ingestion. Mixed subtypes consisted of other combinations of motives, routes, and co-ingestion. Among those who reported nonmedical prescription drug misuse, approximately 13% were classified into the recreational subtype, while 39% were in the self-treatment subtype, and 48% were in the mixed subtype. There were significant differences in the subtypes in terms of gender, race and prescription drug class. Approximately 50% of those in subtypes other than self-treatment screened positive for drug abuse. The odds of substance use and abuse were generally lower among self-treatment subtypes than other subtypes. The findings indicate subtypes should be considered when examining nonmedical prescription drug misuse, especially for pain medication. PMID:19278795

External validation of a multivariable claims-based rule for predicting in-hospital mortality and 30-day post-pulmonary embolism complications

Directory of Open Access Journals (Sweden)

Craig I. Coleman

2016-10-01

Full Text Available Abstract Background Low-risk pulmonary embolism (PE patients may be candidates for outpatient treatment or abbreviated hospital stay. There is a need for a claims-based prediction rule that payers/hospitals can use to risk stratify PE patients. We sought to validate the In-hospital Mortality for PulmonAry embolism using Claims daTa (IMPACT prediction rule for in-hospital and 30-day outcomes. Methods We used the Optum Research Database from 1/2008-3/2015 and included adults hospitalized for PE (415.1x in the primary position or secondary position when accompanied by a primary code for a PE complication and having continuous medical and prescription coverage for ≥6-months prior and 3-months post-inclusion or until death. In-hospital and 30-day mortality and 30-day complications (recurrent venous thromboembolism, rehospitalization or death were assessed and prognostic accuracies of IMPACT with 95 % confidence intervals (CIs were calculated. Results In total, 47,531 PE patients were included. In-hospital and 30-day mortality occurred in 7.9 and 9.4 % of patients and 20.8 % experienced any complication within 30-days. Of the 19.5 % of patients classified as low-risk by IMPACT, 2.0 % died in-hospital, resulting in a sensitivity and specificity of 95.2 % (95 % CI, 94.4–95.8 and 20.7 % (95 % CI, 20.4–21.1. Only 1 additional low-risk patient died within 30-days of admission and 12.2 % experienced a complication, translating into a sensitivity and specificity of 95.9 % (95 % CI, 95.3–96.5 and 21.1 % (95 % CI, 20.7–21.5 for mortality and 88.5 % (95 % CI, 87.9–89.2 and 21.6 % (95 % CI, 21.2–22.0 for any complication. Conclusion IMPACT had acceptable sensitivity for predicting in-hospital and 30-day mortality or complications and may be valuable for retrospective risk stratification of PE patients.

External validation of a multivariable claims-based rule for predicting in-hospital mortality and 30-day post-pulmonary embolism complications.

Science.gov (United States)

Coleman, Craig I; Peacock, W Frank; Fermann, Gregory J; Crivera, Concetta; Weeda, Erin R; Hull, Michael; DuCharme, Mary; Becker, Laura; Schein, Jeff R

2016-10-22

Low-risk pulmonary embolism (PE) patients may be candidates for outpatient treatment or abbreviated hospital stay. There is a need for a claims-based prediction rule that payers/hospitals can use to risk stratify PE patients. We sought to validate the In-hospital Mortality for PulmonAry embolism using Claims daTa (IMPACT) prediction rule for in-hospital and 30-day outcomes. We used the Optum Research Database from 1/2008-3/2015 and included adults hospitalized for PE (415.1x in the primary position or secondary position when accompanied by a primary code for a PE complication) and having continuous medical and prescription coverage for ≥6-months prior and 3-months post-inclusion or until death. In-hospital and 30-day mortality and 30-day complications (recurrent venous thromboembolism, rehospitalization or death) were assessed and prognostic accuracies of IMPACT with 95 % confidence intervals (CIs) were calculated. In total, 47,531 PE patients were included. In-hospital and 30-day mortality occurred in 7.9 and 9.4 % of patients and 20.8 % experienced any complication within 30-days. Of the 19.5 % of patients classified as low-risk by IMPACT, 2.0 % died in-hospital, resulting in a sensitivity and specificity of 95.2 % (95 % CI, 94.4-95.8) and 20.7 % (95 % CI, 20.4-21.1). Only 1 additional low-risk patient died within 30-days of admission and 12.2 % experienced a complication, translating into a sensitivity and specificity of 95.9 % (95 % CI, 95.3-96.5) and 21.1 % (95 % CI, 20.7-21.5) for mortality and 88.5 % (95 % CI, 87.9-89.2) and 21.6 % (95 % CI, 21.2-22.0) for any complication. IMPACT had acceptable sensitivity for predicting in-hospital and 30-day mortality or complications and may be valuable for retrospective risk stratification of PE patients.

Overdosed prescription of paracetamol (acetaminophen) in a teaching hospital.

Science.gov (United States)

Charpiat, B; Henry, A; Leboucher, G; Tod, M; Allenet, B

2012-07-01

Paracetamol is the most commonly used analgesic and antipyretic. Reviews of hospital use of paracetamol are scarce. Little is known about the appropriateness of the dose of paracetamol prescribed for hospitalized adults. The aim of this study was to report on the nature and the frequency of the overdosed prescription of paracetamol observed in adult patients over a 4.5-year period in a teaching hospital. Prescription analysis by pharmacists was performed once a week in six medical and three surgical departments and daily in a post-emergency unit. In cases of prescription error, the pharmacist notified the physician through an electronic alert when a computerized prescription order entry system was available or otherwise by face-to-face discussion. For each drug-related problem detected, the pharmacists recorded relevant details in a database. From October 2006 to April 2011, 44,404 prescriptions were reviewed and 480 alerts related to the overdosed prescription of paracetamol were made (1% of analyzed prescriptions). The extent of errors of dosage was within the intervals [90-120 mg/kg/d] and greater than 120 mg/kg/d for 87 and 11 patients respectively, who were prescribed a single non-combination paracetamol containing product. Sixty alerts concerned co-prescription of at least two paracetamol containing products with similar frequency for computerized (1.4/1000) or handwritten (1.2/1000) prescriptions. Prescriptions of paracetamol for hospitalized adults frequently exceed the recommended dosage. These results highlight the need for increased awareness of unintentional paracetamol overdose and support the initiation of an educational program aimed at physicians and nurses. Copyright © 2012. Published by Elsevier Masson SAS.

Prescription analysis of pediatric outpatient practice in Nagpur city

Directory of Open Access Journals (Sweden)

Pandey Anuja

2010-01-01

Full Text Available Background: Medication errors are probably one of the most common types of medical errors, as medication is the most common health-care intervention. Knowing where and when errors are most likely to occur is generally felt to be the first step in trying to prevent these errors. Objective: To study prescribing patterns and errors in pediatric OPD prescriptions presenting to four community pharmacies across Nagpur city and to compare the prescription error rates across prescriber profiles. Materials and Methods: The study sample included 1376 valid pediatric OPD prescriptions presenting to four randomly selected community pharmacies in Nagpur, collected over a period of 2 months. Confirmed errors in the prescriptions were reviewed and analyzed. The core indicators for drug utilization studies, mentioned by WHO, were used to define errors. Results: The 1376 prescriptions included in the study were for a total of 3435 drugs, prescribed by 41 doctors. Fixed dose formulations dominated the prescribing pattern, many of which were irrational. Prescribing by market name was almost universal and generic prescriptions were for merely 254 (7.4% drugs. The prescribing pattern also indicated polypharmacy with the average number of drugs per encounter of 2.5. Antibiotics were included in 1087 (79% prescriptions, while injectable drugs were prescribed in 22 (1.6% prescriptions. The prescription error score varied significantly across prescriber profiles. Conclusion: The findings of our study highlight the continuing crisis of the irrational drug prescribing in the country.

The feasibility of QR-code prescription in Taiwan.

Science.gov (United States)

Lin, C-H; Tsai, F-Y; Tsai, W-L; Wen, H-W; Hu, M-L

2012-12-01

An ideal Health Care Service is a service system that focuses on patients. Patients in Taiwan have the freedom to fill their prescriptions at any pharmacies contracted with National Health Insurance. Each of these pharmacies uses its own computer system. So far, there are at least ten different systems on the market in Taiwan. To transmit the prescription information from the hospital to the pharmacy accurately and efficiently presents a great issue. This study consisted of two-dimensional applications using a QR-code to capture Patient's identification and prescription information from the hospitals as well as using a webcam to read the QR-code and transfer all data to the pharmacy computer system. Two hospitals and 85 community pharmacies participated in the study. During the trial, all participant pharmacies appraised highly of the accurate transmission of the prescription information. The contents in QR-code prescriptions from Taipei area were picked up efficiently and accurately in pharmacies at Taichung area (middle Taiwan) without software system limit and area limitation. The QR-code device received a patent (No. M376844, March 2010) from Intellectual Property Office Ministry of Economic Affair, China. Our trial has proven that QR-code prescription can provide community pharmacists an efficient, accurate and inexpensive device to digitalize the prescription contents. Consequently, pharmacists can offer better quality of pharmacy service to patients. © 2012 Blackwell Publishing Ltd.

Effect of medication burden on persistent use of lipid-lowering drugs among patients with hypertension.

Science.gov (United States)

Robertson, Teisha A; Cooke, Catherine E; Wang, Jingshu; Shaya, Fadia T; Lee, Helen Y

2008-11-01

To determine the effect of medication burden on persistent use of newly added lipid-lowering (LL) drugs among patients with hypertension. This retrospective database study used medical and pharmacy claims from a mid-Atlantic managed care organization. The cohort was obtained from continuous member enrollment in pharmacy and medical benefits from January 1, 2003, to December 31, 2005. Prescription claims were obtained for 18 months following the date of the first filled LL prescription (ie, index date). Patients were stratified into patients who changed LL drug or strength (group 1) and patients who did not change LL drug or strength (group 2). The primary outcome measure was persistence to newly added LL therapy. Persistence was defined by the length of time a member remained on therapy following the index date. The secondary outcome measure was the medication possession ratio (MPR). The MPR was calculated as the ratio of the sum of the days' supply of prescription filled divided by the number of days filled, plus the days' supply for the final prescription fill. Associations between the daily medication burden, defined as the number of unique drug products, and the outcome measures were analyzed. In the cohort of 3058 patients, the mean medication burden was 2.9 medications. Medication burden was positively associated with persistence and MPR through 18 months. Patients who had greater medication burden had longer persistence (P 80%) (P attention should focus on patients who have changes to their LL regimen compared with patients who continue on the same LL prescription.

PHARMACOEPIDEMIOLOGY OF ANTIMICROBIAL AGENTS IN NEONATOLOGY: RESULTS OF THE RETROSPECTIVE CROSS-SECTIONAL STUDY

Directory of Open Access Journals (Sweden)

Alexey S. Kolbin

2016-01-01

Full Text Available Background. Infectious diseases remain the leading causes of morbidity and mortality worldwide. Against the background of ever-increasing resistance of bacteria, it is necessary to develop effective measures aimed at the structure optimization of consumption of antimicrobial agents. Therefore, the pharmacoepidemiological data describing either the consumption of antimicrobial agents or the resistance level to them is required. Objective: Our aim was to assess the antimicrobial load in term and preterm newborns during their stay in the maternity wards and/or in the intensive care units (ICU. Methods. A retrospective cross-sectional study has been carried out. The analysis included data of 419 newborns from 5 medical centers. The study has been carried out as part of a multi-purpose program on antibiotic resistance containment being held in St. Petersburg from 2014. Results. The antimicrobial load on the child's body expressed in days of the antimicrobial therapy was 1,838 per 1,000 patient-days in children staying in the ICU for not more than 16 days, and 1,434 per 1,000 patient-days when staying in the ICU for more than 16 days. The average duration of the antimicrobial therapy is 28 days in the ICU and 5 days out the ICU (department for newborns, physiological departments. The most commonly, the children were treated with ampicillin — 384 (92%, gentamicin — 254 (61%, and fluconazole — 150 (36%. The prevalence of off-label prescriptions was 41% (of 1,557 analyzed prescriptions, unlicensed prescriptions — 10%. Congenital infections were the main reasons for prescription of antimicrobial drugs — 225 (62%. Conclusion. The high anti-bacterial load in newborns has been established. The indicator 'days of antimicrobial therapy' in the ICU is 4 times higher than that in the United States. The prevalence of off-label and unlicensed prescriptions is comparable with foreign data.

Education as prescription for patients with type 2 diabetes mellitus: compliance and efficacy in clinical practice.

Science.gov (United States)

Kim, Mi Yeon; Suh, Sunghwan; Jin, Sang-Man; Kim, Se Won; Bae, Ji Cheol; Hur, Kyu Yeon; Kim, Sung Hye; Rha, Mi Yong; Cho, Young Yun; Lee, Myung-Shik; Lee, Moon Kyu; Kim, Kwang-Won; Kim, Jae Hyeon

2012-12-01

Diabetes self-management education has an important role in diabetes management. The efficacy of education has been proven in several randomized trials. However, the status of diabetes education programs in real Korean clinical practice has not yet been evaluated in terms of patient compliance with the education prescription. We retrospectively analyzed clinical and laboratory data from all patients who were ordered to undergo diabetes education during 2009 at Samsung Medical Center, Seoul, Korea (n=2,291). After excluding ineligible subjects, 588 patients were included in the analysis. Among the 588 patients, 433 received education. The overall compliance rate was 73.6%, which was significantly higher in the subjects with a short duration or living in a rural area compared to those with a long duration (85.0% vs. 65.1%, respectively; Ppatients refuse to get education despite having a prescription from their physician. This refusal rate was higher in the patients with long-standing diabetes or in urban residence. Furthermore, education was more effective in patients with a short duration of diabetes in clinical practice.

Formalizing Probabilistic Safety Claims

Science.gov (United States)

Herencia-Zapana, Heber; Hagen, George E.; Narkawicz, Anthony J.

2011-01-01

A safety claim for a system is a statement that the system, which is subject to hazardous conditions, satisfies a given set of properties. Following work by John Rushby and Bev Littlewood, this paper presents a mathematical framework that can be used to state and formally prove probabilistic safety claims. It also enables hazardous conditions, their uncertainties, and their interactions to be integrated into the safety claim. This framework provides a formal description of the probabilistic composition of an arbitrary number of hazardous conditions and their effects on system behavior. An example is given of a probabilistic safety claim for a conflict detection algorithm for aircraft in a 2D airspace. The motivation for developing this mathematical framework is that it can be used in an automated theorem prover to formally verify safety claims.

Rationality of Antimicrobial Prescriptions in Community Pharmacy Users.

Directory of Open Access Journals (Sweden)

Sara I V C Lima

Full Text Available Although there is a conflict between the treatment benefits for a single individual and society, restrictions on antibiotic use are needed to reduce the prevalence of resistance to these drugs, which is the main result of irrational use. Brazil, cataloged as a pharmemerging market, has implemented restrictive measures for the consumption of antibiotics. The objective of this study was to investigate the quality of antimicrobial prescriptions and user knowledge of their treatment with these drugs.A two-stage cross-sectional, combined and stratified survey of pharmacy users holding an antimicrobial prescription was conducted in the community between May and November 2014. A pharmacist analyzed each prescription for legibility and completeness, and applied a structured questionnaire to the users or their caregivers on their knowledge regarding treatment and user sociodemographic data. An estimated 29.3% of prescriptions had one or more illegible items, 91.3% had one or more missing items, and 29.0% had both illegible and missing items. Dosing schedule and patient identification were the most commonly unreadable items in prescriptions, 18.81% and 12.14%, respectively. The lack of complete patient identification occurred in 90.53% of the prescriptions. It is estimated that 40.3% of users have used antimicrobials without prescription and that 46.49% did not receive any guidance on the administration of the drug.Despite the measures taken by health authorities to restrict the misuse of antimicrobials, it was observed that prescribers still do not follow the criteria of current legislation, particularly relating to items needed for completion of the prescription. Moreover, users receive little information about their antimicrobial treatment.

Sport-related concussions in New Zealand: a review of 10 years of Accident Compensation Corporation moderate to severe claims and costs.

Science.gov (United States)

King, Doug; Gissane, Conor; Brughelli, Matt; Hume, Patria A; Harawira, Joseph

2014-05-01

This paper provides an overview of the epidemiology of sport-related concussion and associated costs in New Zealand requiring medical treatment from 2001 to 2011 in seven sports codes. A retrospective review of injury entitlement claims by seven sports from 2001 to 2011. Data were analyzed by sporting code, age, ethnicity, gender and year of competition for total and moderate-to-severe (MSC) Accident Compensation Corporation (ACC) claims and costs. A total of 20,902 claims costing $NZD 16,546,026 were recorded over the study period of which 1330 (6.4%) were MSC claims. The mean yearly number and costs of MSC claims were 133 ± 36 and $1,303,942 ± 378,949. Rugby union had the highest number of MSC claims per year (38; 95% CI 36-41 per 1000 MSC claims). New Zealand Māori recorded the highest total ($6,000,759) and mean cost ($21,120) per MSC claim. Although MSC injury claims were only 6.4% of total claims, they accounted for 79.1% of total costs indicating that although the majority of sport-related concussions may be minor in severity, the related economic costs associated with more serious sport-related concussion can be high. The finding that rugby union recorded the most MSC claims in the current study was not unexpected. Of concern is that rugby league recorded a low number of MSC claims but the highest mean cost per claim. Due to the high mean cost per concussion, and the high total and mean cost for New Zealand Māori, further investigation is warranted. Copyright © 2013 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

The appropriateness of a proton pump inhibitor prescription.

LENUS (Irish Health Repository)

Moran, N

2014-11-01

Proton pump inhibitors (PPIs) are one of the most commonly prescribed groups of drug in Ireland, at great expense to the Irish healthcare executive. This study aims to evaluate the appropriateness of PPI prescriptions on admission and discharge in a tertiary referral hospital. All non-elective admissions in the Emergency Department in one week were included in the study. 102 patients in total were included, with 36 (35.4%) treated with a PPI on admission. Of these, only 3 (8.3%) had a clear indication noted as per current NICE guidelines. 18 new in-hospital PPI prescriptions were documented. 11 (61%) of which were present on discharge prescriptions. Continuing PPI prescription on discharge into the community may be inappropriate, costly and potentially harmful. Brief interventions aimed at reducing inappropriate PPI prescriptions have been shown to be effective at reducing the cost and potential harm of unnecessary treatment.

Factors influencing psychotropic prescription by non-psychiatrist physicians in a nursing home for the elderly in Brazil

Directory of Open Access Journals (Sweden)

Florindo Stella

Full Text Available CONTEXT AND OBJECTIVE: Although psychotropics are one of the classes of medications most prescribed in nursing homes for the elderly, studies examining prescribing patterns are limited in both number and scope. The present study was undertaken to investigate factors associated with general psychotropic use in a nursing home in Brazil. DESIGN AND SETTING: Retrospective observational study at the Nursing Home for the Elderly, Institute of Biosciences, Universidade Estadual Paulista. METHODS: Information on prescriptions was retrieved from the medical records of 108 elderly residents in a nursing home. Sixty-five of these patients, with mean age 74.5 years (± standard deviation 9.4 years, who were taking medications on a regular basis, comprised the sample. The effects of demographic and clinical variables on the psychotropic prescription pattern were examined. RESULTS: Females were more likely to receive psychotropics (p = 0.038. Individuals on medicines for cardiovascular diseases received psychotropics less frequently (p = 0.001. The number of prescribed psychotropics correlated negatively with both age (p = 0.009 and number of non-psychotropic drugs (p = 0.009. CONCLUSIONS: Although preliminary, the present results indicated that cardiovascular disease was the clinical variable that most influenced psychotropic prescription. Physicians' overconcern regarding drug interactions might at least partially explain this result. Further investigations involving larger sample sizes from different regions are warranted to confirm these findings.

32 CFR 536.77 - Applicable law for claims under the Military Claims Act.

Science.gov (United States)

2010-07-01

... contributory negligence be interpreted and applied according to the law of the place of the occurrence... 32 National Defense 3 2010-07-01 2010-07-01 true Applicable law for claims under the Military... Act § 536.77 Applicable law for claims under the Military Claims Act. (a) General principles—(1) Tort...

[Failure mode and effects analysis on computerized drug prescriptions].

Science.gov (United States)

Paredes-Atenciano, J A; Roldán-Aviña, J P; González-García, Mercedes; Blanco-Sánchez, M C; Pinto-Melero, M A; Pérez-Ramírez, C; Calvo Rubio-Burgos, Miguel; Osuna-Navarro, F J; Jurado-Carmona, A M

2015-01-01

To identify and analyze errors in drug prescriptions of patients treated in a "high resolution" hospital by applying a Failure mode and effects analysis (FMEA).Material and methods A multidisciplinary group of medical specialties and nursing analyzed medical records where drug prescriptions were held in free text format. An FMEA was developed in which the risk priority index (RPI) was obtained from a cross-sectional observational study using an audit of the medical records, carried out in 2 phases: 1) Pre-intervention testing, and (2) evaluation of improvement actions after the first analysis. An audit sample size of 679 medical records from a total of 2,096 patients was calculated using stratified sampling and random selection of clinical events. Prescription errors decreased by 22.2% in the second phase. FMEA showed a greater RPI in "unspecified route of administration" and "dosage unspecified", with no significant decreases observed in the second phase, although it did detect, "incorrect dosing time", "contraindication due to drug allergy", "wrong patient" or "duplicate prescription", which resulted in the improvement of prescriptions. Drug prescription errors have been identified and analyzed by FMEA methodology, improving the clinical safety of these prescriptions. This tool allows updates of electronic prescribing to be monitored. To avoid such errors would require the mandatory completion of all sections of a prescription. Copyright © 2014 SECA. Published by Elsevier Espana. All rights reserved.

Prescriptions, Nonmedical Use, and Emergency Department Visits Involving Prescription Stimulants

Science.gov (United States)

Chen, Lian-Yu; Crum, Rosa M.; Strain, Eric C.; CalebAlexander, G.; Kaufmann, Christopher; Mojtabai, Ramin

2018-01-01

Objective Little is known regarding the temporal trends in prescription, nonmedical use and emergency department (ED) visits involving prescription stimulants in the United States. We aimed to examine the three national trends involving dextroamphetamine-amphetamin (Adderall) and methylphenidate in adults and adolescents. Method Three national surveys conducted between 2006-2011 were used: National Disease and Therapeutic Index (NDTI), a survey of office-based practices, National Survey on Drug Use and Health (NSDUH), a population survey of substance use, and Drug Abuse Warning Network (DAWN), a survey of ED visits. Ordinary least square regression was used to examine temporal changes over time and the associations between these three trends. Results In adolescents, treatment visits involving dextroamphetamine-amphetamine and methylphenidate decreased over time; nonmedical dextroamphetamine-amphetamine use remained stable while nonmedical methylphenidate use declined by 54.4% in 6 years. ED visits involving either medication remained stable. In adults, treatment visits involving dextroamphetamine-amphetamine remained unchanged while nonmedical use went up by 67% and ED visits went up by 156%. These three trends involving methylphenidate remained unchanged. The major source for both medications was a friend or relative across age groups; two-thirds of these friends/relatives had obtained the medication from a physician. Conclusions Trends of prescriptions for stimulants do not correspond to trends in reports of nonmedical use and ED visits. Increased nonmedical stimulant use may not be simply attributed to increased prescribing trends. Future studies should focus on deeper understanding of the proportion, risk factors and motivations for drug diversions. PMID:26890573

Identification and management of prescription drug abuse in pregnancy.

Science.gov (United States)

Worley, Julie

2014-01-01

Prescription drug abuse is a growing problem in the United States and many other countries. Estimates of prescription drug abuse rates during pregnancy range from 5% to 20%. The primary prescription drugs designated as controlled drugs with abuse potential in pregnancy are opiates prescribed for pain, benzodiazepines prescribed for anxiety, and stimulants prescribed for attention-deficit/hyperactivity disorder. Prescription drugs are obtained for abuse through diversion methods, such as purchasing them from others or by doctor shopping. The use of prescription drugs puts both the mother and the fetus at high risk during pregnancy. Identification of women who are abusing prescription drugs is important so that treatment can be ensured. It is crucial for healthcare professionals to use a multidisciplinary approach and be supportive and maintain a good rapport with pregnant women who abuse prescription drugs. Management includes inpatient hospitalization for detoxification and withdrawal symptoms, and in the case of opiate abuse, opiate maintenance is recommended for pregnant women for the duration of their pregnancy to reduce relapse rates and improve maternal and fetal outcomes. Other recommendations include referral for support groups and supportive housing.

Trends in oral anti-osteoporosis drug prescription in the United Kingdom between 1990 and 2012: Variation by age, sex, geographic location and ethnicity.

Science.gov (United States)

van der Velde, R Y; Wyers, C E; Teesselink, E; Geusens, P P M M; van den Bergh, J P W; de Vries, F; Cooper, C; Harvey, N C; van Staa, T P

2017-01-01

Given the expected increase in the number of patients with osteoporosis and fragility fractures it is important to have concise information on trends in prescription rates of anti-osteoporosis drugs (AOD). We undertook a retrospective observational study using the UK Clinical Practice Research Datalink (CPRD) in the UK between 1990 and 2012 in subjects 50years or older, stratified by age, sex, geographic region and ethnicity. Yearly prescription incidence rates of any AOD and of each specific AOD were calculated as the number of patients first prescribed these AODs per 10,000person-years (py). In women, yearly rates of first prescription of any AOD increased from 1990 to 2006 (from 2.3 to 169.7 per 10,000py), followed by a plateau and a 12% decrease in the last three years. In men, a less steep increase from 1990 to 2007 (from 1.4 to 45.3 per 10,000py) was followed by a plateau from 2008 onwards. Yearly rates of first prescription of any AOD increased up to the age of 85-89years (248.9 per 10,000py in women and 119.3 in men). There were marked differences between ethnic groups and regions. Bisphosphonates were the most frequently prescribed AODs: etidronate till 2000, and then subsequently alendronate. We have demonstrated marked secular changes in rates of anti-osteoporosis drug prescription over the last two decades. The plateau (and decrease amongst women) in rates in recent years, set against an ever ageing population, is worrying, suggesting that the well-documented care gap in osteoporosis treatment persists. The differences in prescription rates by geographic location and ethnicity raise intriguing questions in relation to underlying fracture rates, provision of care and health behaviour. We studied the prescription incidence of anti-osteoporosis drugs (AOD) from 1990 to 2012 in the UK CPRD. Overall AOD prescription incidence showed a strong increase from 1990 to 2006, followed by a plateau in both sexes and a decrease amongst women in the last three years

Nature, frequency and determinants of prescription modifications in Dutch community pharmacies

Science.gov (United States)

Buurma, Henk; de Smet, Peter A G M; van den Hoff, Olga P; Egberts, Antoine C G

2001-01-01

Aims To examine the nature, frequency and determinants of prescription modifications in Dutch community pharmacies. Methods A prospective case-control study comparing modified prescriptions with nonmodified prescriptions was carried out in 141 Dutch community pharmacies. 2014 modified prescriptions (cases), collected in the selected pharmacies on a predetermined day in a specific period (25th February until 12th March 1999) and 2581 nonmodified prescriptions (controls) randomly selected on the same day were studied. The nature and frequency of prescription modifications and patient, drug and prescriber related determinants for a modified prescription were assessed. Results The overall incidence of prescription modifications was 4.3%, with a mean of 14.3 modifications per pharmacy per day. For prescription only medicines (POM) the incidence was 4.9%. The majority of POM modifications concerned a clarification (71.8%). In 22.2% a prescription could potentially have had clinical consequences when not altered; in more than half of the latter it concerned a dose error (13.7% of all cases). POM prescriptions of patients of 40–65 years had a significantly lower chance of modification compared with those of younger people (OR = 0.74 [0.64–0.86]). With respect to medication-class, we found a higher chance of POM modifications in the respiratory domain (OR = 1.48 [1.23-1.79]) and a decreased chance for nervous system POMs (OR = 0.71 [0.61–0.83]). With regard to prescriber-related determinants modifications were found three times more often in non printed prescriptions than in printed ones (OR = 3.30 [2.90-3.75]). Compared with prescriptions by the patient's own GP, prescriptions of specialists (OR = 1.82 [1.57-2.11]), other GP's (OR = 1.49 [1.02-2.17]) and other prescribers such as dentists and midwives (OR = 1.95 [1.06-3.57]) gave a higher probability of prescription modifications. When a GP had no on-line access to the computer of the pharmacy the chance of a

Ultra-processed family foods in Australia: nutrition claims, health claims and marketing techniques.

Science.gov (United States)

Pulker, Claire Elizabeth; Scott, Jane Anne; Pollard, Christina Mary

2018-01-01

To objectively evaluate voluntary nutrition and health claims and marketing techniques present on packaging of high-market-share ultra-processed foods (UPF) in Australia for their potential impact on public health. Cross-sectional. Packaging information from five high-market-share food manufacturers and one retailer were obtained from supermarket and manufacturers' websites. Ingredients lists for 215 UPF were examined for presence of added sugar. Packaging information was categorised using a taxonomy of nutrition and health information which included nutrition and health claims and five common food marketing techniques. Compliance of statements and claims with the Australia New Zealand Food Standards Code and with Health Star Ratings (HSR) were assessed for all products. Almost all UPF (95 %) contained added sugars described in thirty-four different ways; 55 % of UPF displayed a HSR; 56 % had nutrition claims (18 % were compliant with regulations); 25 % had health claims (79 % were compliant); and 97 % employed common food marketing techniques. Packaging of 47 % of UPF was designed to appeal to children. UPF carried a mean of 1·5 health and nutrition claims (range 0-10) and 2·6 marketing techniques (range 0-5), and 45 % had HSR≤3·0/5·0. Most UPF packaging featured nutrition and health statements or claims despite the high prevalence of added sugars and moderate HSR. The degree of inappropriate or inaccurate statements and claims present is concerning, particularly on packaging designed to appeal to children. Public policies to assist parents to select healthy family foods should address the quality and accuracy of information provided on UPF packaging.

Claims-based definition of death in Japanese claims database: validity and implications.

Science.gov (United States)

Ooba, Nobuhiro; Setoguchi, Soko; Ando, Takashi; Sato, Tsugumichi; Yamaguchi, Takuhiro; Mochizuki, Mayumi; Kubota, Kiyoshi

2013-01-01

For the pending National Claims Database in Japan, researchers will not have access to death information in the enrollment files. We developed and evaluated a claims-based definition of death. We used healthcare claims and enrollment data between January 2005 and August 2009 for 195,193 beneficiaries aged 20 to 74 in 3 private health insurance unions. We developed claims-based definitions of death using discharge or disease status and Charlson comorbidity index (CCI). We calculated sensitivity, specificity and positive predictive values (PPVs) using the enrollment data as a gold standard in the overall population and subgroups divided by demographic and other factors. We also assessed bias and precision in two example studies where an outcome was death. The definition based on the combination of discharge/disease status and CCI provided moderate sensitivity (around 60%) and high specificity (99.99%) and high PPVs (94.8%). In most subgroups, sensitivity of the preferred definition was also around 60% but varied from 28 to 91%. In an example study comparing death rates between two anticancer drug classes, the claims-based definition provided valid and precise hazard ratios (HRs). In another example study comparing two classes of anti-depressants, the HR with the claims-based definition was biased and had lower precision than that with the gold standard definition. The claims-based definitions of death developed in this study had high specificity and PPVs while sensitivity was around 60%. The definitions will be useful in future studies when used with attention to the possible fluctuation of sensitivity in some subpopulations.

Nonmedical Prescription Drug Use: Theory and Policy Implications

OpenAIRE

Gabriele Camera; Bryan Engelhardt

2014-01-01

The illicit nonmedical use of prescription drugs is studied in a model where individuals with imperfectly observable health conditions seek prescription drugs for either medical or nonmedical reasons. The equilibrium number of medical and nonmedical users is endogenous and depends on economic and non-economic barriers to drugs consumption, such as pricing, health care costs, refill policies, monitoring programs, and the medical community’s prescription standards. The results show policies cen...

76 FR 51310 - Branded Prescription Drug Fee

Science.gov (United States)

2011-08-18

... Branded Prescription Drug Fee AGENCY: Internal Revenue Service (IRS), Treasury. ACTION: Notice of proposed... issue of the Federal Register, the IRS is issuing temporary regulations relating to the branded... business of manufacturing or importing certain branded prescription drugs. The text of the temporary...

Age- and weight-based differences in haemodialysis prescription and delivery in children, adolescents and young adults.

Science.gov (United States)

Gotta, Verena; Marsenic, Olivera; Pfister, Marc

2018-04-18

Limited systematic data are available on prescription and dosing of haemodialysis (HD) in children and adolescents compared with adults. We aimed to characterize age- and weight-based differences in HD delivery in children, adolescents and young adults. This is a retrospective observational study including 1852 patients aged 1-18 years; weight range 8.3-168 kg). Median individual prescriptions per year were calculated and overall 50% (IQR) and 90% distribution ranges over age and weight were derived. Repeated measurements analysis of variance assessed differences between age and weight groups. Prescriptions significantly differed among age and weight groups (P range, IQR) weight-normalized blood flow rate (highest in 100 kg: QB/kg = 3.1-4.0 mL/min/kg, spKt/V = 1.22-1.47, respectively). Adolescents had significantly lower QB/kg, KD/kg and spKt/V (1.34-1.71) compared with adults (1.45-1.79) and children range of 25th percentiles: 1.37-1.44). Dialytic clearance derived from a mechanistic equation underpredicted KD in children but not in young adults. Significant growth retardation was observed, with the proportion of patients age) decreasing from 71% (1-2 years) to 15% (>18 years). Delivered HD treatment varies with age and weight and is more intensified in children aged young adults, who appear to be at highest risk of receiving suboptimal treatment. Still, delivery of target or higher spKt/V values did not result in appropriate growth in these children, questioning the value of spKt/V as a measure of HD adequacy in children. Provided ranges of outpatient HD prescription can help clinicians and researchers in personalizing and optimizing delivery of dialysis treatment.

Are Prescription Stimulants "Smart Pills"? The Epidemiology and Cognitive Neuroscience of Prescription Stimulant Use by Normal Healthy Individuals

Science.gov (United States)

Smith, M. Elizabeth; Farah, Martha J.

2011-01-01

Use of prescription stimulants by normal healthy individuals to enhance cognition is said to be on the rise. Who is using these medications for cognitive enhancement, and how prevalent is this practice? Do prescription stimulants in fact enhance cognition for normal healthy people? We review the epidemiological and cognitive neuroscience…

Claiming health in food products

DEFF Research Database (Denmark)

Lähteenmäki, Liisa

2013-01-01

Health-related information is increasingly used on food products to convey their benefits. Health claims as a subcategory of these messages link the beneficial component, functions or health outcomes with specific products. For consumers, health claims seem to carry the message of increased...... healthiness, but not necessarily making the product more appealing. The wording of the claim seems to have little impact on claim perception, yet the health image of carrier products is important. From consumer-related factors the relevance and attitudes towards functional foods play a role, whereas socio......-demographic factors have only minor impact and the impact seems to be case-dependent. Familiarity with claims and functional foods increase perceived healthiness and acceptance of these products. Apparently consumers make rather rational interpretations of claims and their benefits when forced to assess...

Warranty claim analysis considering human factors

International Nuclear Information System (INIS)

Wu Shaomin

2011-01-01

Warranty claims are not always due to product failures. They can also be caused by two types of human factors. On the one hand, consumers might claim warranty due to misuse and/or failures caused by various human factors. Such claims might account for more than 10% of all reported claims. On the other hand, consumers might not be bothered to claim warranty for failed items that are still under warranty, or they may claim warranty after they have experienced several intermittent failures. These two types of human factors can affect warranty claim costs. However, research in this area has received rather little attention. In this paper, we propose three models to estimate the expected warranty cost when the two types of human factors are included. We consider two types of failures: intermittent and fatal failures, which might result in different claim patterns. Consumers might report claims after a fatal failure has occurred, and upon intermittent failures they might report claims after a number of failures have occurred. Numerical examples are given to validate the results derived.

Complications and patient-injury after ankle fracture surgery. -A closed claim analysis with data from the Patient Compensation Association in Denmark

DEFF Research Database (Denmark)

Bjørslev, Naja; Ebskov, Lars Bo; Mersø, Camilla

2018-01-01

BACKGROUND: The Patient Compensation Association (PCA) receives claims for financial compensation from patients who believe they have sustained damage from their treatment in the Danish health care system. In this study, we have analysed closed claims in which patients suffered injuries due...... to the surgical treatment of their ankle fracture. We identified causalities contributing to these injuries and malpractices, as well as the economic consequences of these damages. METHODS: Fifty-one approved closed claims from the PCA database from the years 2004-2009 were analysed in a retrospective systematic...... of damages. General recommendations regarding ORIF were not followed in 21/49 of the perioperative damages. The pronation fracture was the most common. The patients received a total average compensation of 17.561 USD each. CONCLUSION: Managing the complex ankle fracture, requires considerable experience...

Automated Prescription of Oblique Brain 3D MRSI

OpenAIRE

Ozhinsky, Eugene; Vigneron, Daniel B.; Chang, Susan M.; Nelson, Sarah J.

2012-01-01

Two major difficulties encountered in implementing Magnetic Resonance Spectroscopic Imaging (MRSI) in a clinical setting are limited coverage and difficulty in prescription. The goal of this project was to completely automate the process of 3D PRESS MRSI prescription, including placement of the selection box, saturation bands and shim volume, while maximizing the coverage of the brain. The automated prescription technique included acquisition of an anatomical MRI image, optimization of the ob...

Effects of externally rated job demand and control on depression diagnosis claims in an industrial cohort.

Science.gov (United States)

DeSanto Iennaco, Joanne; Cullen, Mark R; Cantley, Linda; Slade, Martin D; Fiellin, Martha; Kasl, Stanislav V

2010-02-01

This study examined whether externally rated job demand and control were associated with depression diagnosis claims in a heavy industrial cohort. The retrospective cohort sample consisted of 7,566 hourly workers aged 18-64 years who were actively employed at 11 US plants between January 1, 1996, and December 31, 2003, and free of depression diagnosis claims during an initial 2-year run-in period. Logistic regression analysis was used to model the effect of tertiles of demand and control exposure on depression diagnosis claims. Demand had a significant positive association with depression diagnosis claims in bivariate models and models adjusted for demographic (age, gender, race, education, job grade, tenure) and lifestyle (smoking status, body mass index, cholesterol level) variables (high demand odds ratio = 1.39, 95% confidence interval: 1.04, 1.86). Control was associated with greater risk of depression diagnosis at moderate levels in unadjusted models only (odds ratio = 1.47, 95% confidence interval: 1.12, 1.93), while low control, contrary to expectation, was not associated with depression. The effects of the externally rated demand exposure were lost with adjustment for location. This may reflect differences in measurement or classification of exposure, differences in depression diagnosis by location, or other location-specific factors.

Claims-Based Definition of Death in Japanese Claims Database: Validity and Implications

Science.gov (United States)

Ooba, Nobuhiro; Setoguchi, Soko; Ando, Takashi; Sato, Tsugumichi; Yamaguchi, Takuhiro; Mochizuki, Mayumi; Kubota, Kiyoshi

2013-01-01

Background For the pending National Claims Database in Japan, researchers will not have access to death information in the enrollment files. We developed and evaluated a claims-based definition of death. Methodology/Principal Findings We used healthcare claims and enrollment data between January 2005 and August 2009 for 195,193 beneficiaries aged 20 to 74 in 3 private health insurance unions. We developed claims-based definitions of death using discharge or disease status and Charlson comorbidity index (CCI). We calculated sensitivity, specificity and positive predictive values (PPVs) using the enrollment data as a gold standard in the overall population and subgroups divided by demographic and other factors. We also assessed bias and precision in two example studies where an outcome was death. The definition based on the combination of discharge/disease status and CCI provided moderate sensitivity (around 60%) and high specificity (99.99%) and high PPVs (94.8%). In most subgroups, sensitivity of the preferred definition was also around 60% but varied from 28 to 91%. In an example study comparing death rates between two anticancer drug classes, the claims-based definition provided valid and precise hazard ratios (HRs). In another example study comparing two classes of anti-depressants, the HR with the claims-based definition was biased and had lower precision than that with the gold standard definition. Conclusions/Significance The claims-based definitions of death developed in this study had high specificity and PPVs while sensitivity was around 60%. The definitions will be useful in future studies when used with attention to the possible fluctuation of sensitivity in some subpopulations. PMID:23741526

Influence of pharmacists expertise on physicians prescription ...

African Journals Online (AJOL)

Purpose: To explore the influence of pharmacist factors on prescription decisions of physicians. Methods: A survey of literature was carried out across online databases and 12 relevant articles were identified. The influence of pharmacist factors on physician prescription decisions was identified in the articles. A conceptual ...

Prescription Drug Plan Formulary, Pharmacy Network, and P...

Data.gov (United States)

U.S. Department of Health & Human Services — These public use files contain formulary, pharmacy network, and pricing data for Medicare Prescription Drug Plans and Medicare Advantage Prescription Drug Plans...

Utilization of genetic tests: analysis of gene-specific billing in Medicare claims data.

Science.gov (United States)

Lynch, Julie A; Berse, Brygida; Dotson, W David; Khoury, Muin J; Coomer, Nicole; Kautter, John

2017-08-01

We examined the utilization of precision medicine tests among Medicare beneficiaries through analysis of gene-specific tier 1 and 2 billing codes developed by the American Medical Association in 2012. We conducted a retrospective cross-sectional study. The primary source of data was 2013 Medicare 100% fee-for-service claims. We identified claims billed for each laboratory test, the number of patients tested, expenditures, and the diagnostic codes indicated for testing. We analyzed variations in testing by patient demographics and region of the country. Pharmacogenetic tests were billed most frequently, accounting for 48% of the expenditures for new codes. The most common indications for testing were breast cancer, long-term use of medications, and disorders of lipid metabolism. There was underutilization of guideline-recommended tumor mutation tests (e.g., epidermal growth factor receptor) and substantial overutilization of a test discouraged by guidelines (methylenetetrahydrofolate reductase). Methodology-based tier 2 codes represented 15% of all claims billed with the new codes. The highest rate of testing per beneficiary was in Mississippi and the lowest rate was in Alaska. Gene-specific billing codes significantly improved our ability to conduct population-level research of precision medicine. Analysis of these data in conjunction with clinical records should be conducted to validate findings.Genet Med advance online publication 26 January 2017.

ADA perceived disability claims: a decision-tree analysis.

Science.gov (United States)

Draper, William R; Hawley, Carolyn E; McMahon, Brian T; Reid, Christine A; Barbir, Lara A

2014-06-01

The purpose of this study is to examine the possible interactions of predictor variables pertaining to perceived disability claims contained in a large governmental database. Specifically, it is a retrospective analysis of US Equal Employment Opportunity Commission (EEOC) data for the entire population of workplace discrimination claims based on the "regarded as disabled" prong of the Americans with Disabilities Act (ADA) definition of disability. The study utilized records extracted from a "master database" of over two million charges of workplace discrimination in the Integrated Mission System of the EEOC. This database includes all ADA-related discrimination allegations filed from July 26, 1992 through December 31, 2008. Chi squared automatic interaction detection (CHAID) was employed to analyze interaction effects of relevant variables, such as issue (grievance) and industry type. The research question addressed by CHAID is: What combination of factors are associated with merit outcomes for people making ADA EEOC allegations who are "regarded as" having disabilities? The CHAID analysis shows how merit outcome is predicted by the interaction of relevant variables. Issue was found to be the most prominent variable in determining merit outcome, followed by industry type, but the picture is made more complex by qualifications regarding age and race data. Although discharge was the most frequent grievance among charging parties in the perceived disability group, its merit outcome was significantly less than that for the leading factor of hiring.

Antibiotic Prescription in Danish General Practice

DEFF Research Database (Denmark)

Sydenham, Rikke Vognbjerg; Plejdrup Hansen, Malene; Pedersen, Line Bjørnskov

2016-01-01

1. Background & Aim The overall aim of the project is to describe antibiotic consumption in Danish general practice with emphasis on specific types of antibiotics. The project will shed light on the impact of microbiological diagnostic methods (MDM) on the choice of antibiotic and the project...... will explore how the GPs prescription behaviour is influenced by selected factors. Antibiotics are essential when treating potentially lethal infections. An increasing development of resistant bacteria is considered one of the primary threats to public health. The majority of antibiotics (90%) are prescribed...... from general practice. The prescription of broad-spectrum antibiotics can cause unnecessary side effects for the individual and increases the risk of development of bacteria resistant to antibiotic treatment. Both the prescription of broad-spectrum antibiotics and the level of resistant bacteria...

Prescription Drug Abuse: From Epidemiology to Public Policy

OpenAIRE

McHugh, R. Kathryn; Nielsen, Suzanne; Weiss, Roger D.

2014-01-01

Prescription drug abuse has reached an epidemic level in the United States. The prevalence of prescription drug abuse escalated rapidly beginning in the late 1990s, requiring a significant increase in research to better understand the nature and treatment of this problem. Since this time, a research literature has begun to develop and has provided important information about how prescription drug abuse is similar to, and different from the abuse of other substances. This introduction to a spe...

The economic impact of Marfan syndrome: a non-experimental, retrospective, population-based matched cohort study.

Science.gov (United States)

Achelrod, Dmitrij; Blankart, Carl Rudolf; Linder, Roland; von Kodolitsch, Yskert; Stargardt, Tom

2014-06-23

Marfan syndrome is a rare disease of the connective tissues, affecting multiple organ systems. Elevated morbidity and mortality in these patients raises the issue of costs for sickness funds and society. To date, there has been no study analysing the costs of Marfan syndrome from a sickness fund and societal perspective. To estimate excess health resource utilisation, direct (non-)medical and indirect costs attributable to Marfan syndrome from a healthcare payer and a societal perspective in Germany in 2008. A retrospective matched cohort study design is applied, using claims data. For isolating the causal effect of Marfan syndrome on excess costs, a genetic matching algorithm was used to reduce differences in observable characteristics between Marfan syndrome patients and the control group. 892 patients diagnosed with Marfan syndrome (ICD-10 Q87.4) were matched from a pool of 26,645 control individuals. After matching, we compared health resource utilisation and costs. From the sickness fund perspective, an average Marfan syndrome patient generates excess annual costs of €2496 compared with a control individual. From the societal perspective, excess annual costs amount to €15,728. For the sickness fund, the strongest cost drivers are inpatient treatment and care by non-physicians. From the sickness fund perspective, the third (25-41 years) and first (0-16 years) age quartiles reveal the greatest surplus in total costs. Marfan syndrome patients have 39% more physician contacts, a 153% longer average length of hospital stay, 119% more inpatient stays, 33% more prescriptions, 236% more medical imaging and 20% higher average prescription costs than control individuals. Depending on the prevalence, the economic impact from the sickness fund perspective ranges between €24.0 million and €61.4 million, whereas the societal economic impact extends from €151.3 million to €386.9 million. Relative to its low frequency, Marfan syndrome requires high healthcare

Automated Prescription of Oblique Brain 3D MRSI

Science.gov (United States)

Ozhinsky, Eugene; Vigneron, Daniel B.; Chang, Susan M.; Nelson, Sarah J.

2012-01-01

Two major difficulties encountered in implementing Magnetic Resonance Spectroscopic Imaging (MRSI) in a clinical setting are limited coverage and difficulty in prescription. The goal of this project was to completely automate the process of 3D PRESS MRSI prescription, including placement of the selection box, saturation bands and shim volume, while maximizing the coverage of the brain. The automated prescription technique included acquisition of an anatomical MRI image, optimization of the oblique selection box parameters, optimization of the placement of OVS saturation bands, and loading of the calculated parameters into a customized 3D MRSI pulse sequence. To validate the technique and compare its performance with existing protocols, 3D MRSI data were acquired from 6 exams from 3 healthy volunteers. To assess the performance of the automated 3D MRSI prescription for patients with brain tumors, the data were collected from 16 exams from 8 subjects with gliomas. This technique demonstrated robust coverage of the tumor, high consistency of prescription and very good data quality within the T2 lesion. PMID:22692829

Prescription Writing Errors of Midwifery Students in Common Gynecological problems

Directory of Open Access Journals (Sweden)

Serveh Parang

2014-04-01

Full Text Available Background and aim: Giving improper prescriptions is common among medical practitioners, mostly graduates, in most communities even developed countries. So far, to our knowledge, no study has been conducted on prescription writing of graduate midwifery students. Therefore, this study aimed to detect prescription writing errors of midwifery students in common gynecological problems. Methods: In this descriptive cross-sectional study, 56 bachelor midwifery students, who had passed the theoretical and clinical courses of gynecology, were evaluated by Objective Structured Clinical Examination (OSCE. A demographic questionnaire and a standard checklist for writing the prescriptions and medications were used for data collection. SPSS Version 16 was used to carry out descriptive statistics. Findings: Most of the students were single, with the mean age of 23.0±1.7 years. Most errors were related to not recording the patients’ age and sex, diagnosis, chief complaint, and the prescriber’s name (observed in less than 10% of the prescriptions. The complete dosage schedule and drug name were stated only in 1.8±4.8 and 14±18.6 of prescriptions, respectively. In more than 93% of the cases, route of use and treatment duration were not recorded. Conclusion: According to the results, the number of prescription errors of midwifery students was high. Therefore, it is recommended to run educational courses on prescription writing skills (e.g. writing prescriptions based on World Health Organization (WHO guidelines for the midwifery students.

Bodily differences between Cold- and Heat-prescription groups in Sasang medicine

Directory of Open Access Journals (Sweden)

Young Joo Park

2016-06-01

Conclusion: In the SY-type men, the chest circumference was significantly greater in the Heat-prescription group compared to the Cold-prescription group. In the TE-type men, the rib-to-pelvic circumference ratio was significantly higher in the Heat-prescription group than in the Cold-prescription group.

[Appropriateness of the prescriptions of conventional versus new oral anticoagulants at discharge from a department of internal medicine].

Science.gov (United States)

Bochatay, L; Beney, J; Jordan-von Gunten, V; Petignat, P A; Roulet, L

2016-09-01

The recently introduced oral direct anticoagulants (ODAs), presumably safer, and with comparable efficacy to the vitamin K antagonists (VKAs), may reshape the world of anticoagulation medicine. This study aimed to assess the prescription appropriateness of ODAs and VKAs at discharge from hospital. We performed a one year retrospective study between August 2012 and July 2013 in the department of internal medicine of a regional hospital (HVs Sion) using Electronic Medical Records. All patients receiving an ODA were included and matched to a patient treated with a VKA. The appropriateness of prescription at discharge was defined by an adequate indication and dosing, the absence of contraindication, a minimal risk of drug-drug interactions and no major bleeding or venous thromboembolism during the hospitalization. The bleeding risk was evaluated with the HAS-BLED score when the indication was atrial fibrillation (AF). Out of the 44patients included (22 with an ODA and 22 with a VKA), 38 received an appropriate prescription according to all criteria. Two patients had an inadequate dosing. A potential drug-drug interaction was detected in 3patients receiving a VKA and in 1patient receiving an ODA. No major contraindication was found, but a relative contraindication was discussed in 3cases. The majority of patients receiving an ODA for an AF had a minor bleeding risk. No significant difference was ascertained between the two groups regarding the appropriateness of prescription. Our results suggest that ODAs were cautiously used in our setting. Copyright © 2015 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier SAS. All rights reserved.

Scope of claim coverage in patents of fufang Chinese herbal drugs: Substitution of ingredients

Directory of Open Access Journals (Sweden)

Tian Jiaher

2011-08-01

Full Text Available Abstract Herbal ingredients in a Chinese fufang prescription are often replaced by one or several other herbal combinations. As there have been very few Chinese herbal patent infringement cases, it is still unclear how the Doctrine of Equivalents should be applied to determine the scope of 'equivalents' in Chinese fufang prescriptions. Case law principles from cases in other technical areas such as chemical patents and biological drug patents can be borrowed to ascertain a precise scope of a fufang patent. This article summarizes and discusses several chemical and biopharmaceutical patent cases. In cases where a certain herbal ingredient is substituted by another herb or a combination of herbs, accused infringers are likely to relate herbal drug patents to chemical drug patents with strict interpretation whereas patent owners may take advantage of the liberal application of Doctrine of Equivalence in biopharmaceutical patents by analogizing the complex nature of herbal drugs with biological drugs. Therefore, consideration should be given to the purpose of an ingredient in a patent, the qualities when combined with the other ingredients and the intended function. The scope of equivalents also depends on the stage of the prior art. Moreover, it is desirable to disclose any potential substitutes when drafting the application. Claims should be drafted in such a way that all foreseeable modifications are encompassed for the protection of the patent owner's intellectual property.

Claims in civil engineering contracts

CERN Document Server

Speirs, N A

1999-01-01

This paper considers claims arising during civil engineering construction contracts. The meaning of the word 'claim' is considered and its possible implications for additional cost and time to completion. The conditions of the construction contract selected will influence the risk apportionment between contractor and client and the price offered by the contractor for the work. Competitive bidding constraints and profit margins in the construction industry, however, may also influence the price offered. This in turn can influence the likelihood of claims arising. The client from his point of view is concerned to complete the work within an agreed time and budget. The circumstances under which claims may arise are reviewed in relation to typical conditions of contract. These circumstances are then related to the CERN LHC civil works. Ways of avoiding claims, where this is possible, are considered. Finally, the means of evaluation of claims and their settlement are considered.

[Analysis on traditional Chinese medicine prescriptions treating cancer-related anorexia syndrome based on grey system theory combined with multivariate analysis method and discovery of new prescriptions].

Science.gov (United States)

Chen, Song-Lin; Chen, Cong; Zhu, Hui; Li, Jing; Pang, Yan

2016-01-01

Cancer-related anorexia syndrome (CACS) is one of the main causes for death at present as well as a syndrome seriously harming patients' quality of life, treatment effect and survival time. In current clinical researches, there are fewer reports about empirical traditional Chinese medicine(TCM) prescriptions and patent prescriptions treating CACS, and prescription rules are rarely analyzed in a systematic manner. As the hidden rules are not excavated, it is hard to have an innovative discovery and knowledge of clinical medication. In this paper, the grey screening method combined with the multivariate statistical method was used to build the ″CACS prescriptions database″. Based on the database, totally 359 prescriptions were selected, the frequency of herbs in prescription was determined, and commonly combined drugs were evolved into 4 new prescriptions for different syndromes. Prescriptions of TCM in treatment of CACS gave priority to benefiting qi for strengthening spleen, also laid emphasis on replenishing kidney essence, dispersing stagnated liver-qi and dispersing lung-qi. Moreover, interdependence and mutual promotion of yin and yang should be taken into account to reflect TCM's holism and theory for treatment based on syndrome differentiation. The grey screening method, as a valuable traditional Chinese medicine research-supporting method, can be used to subjectively and objectively analyze prescription rules; and the new prescriptions can provide reference for the clinical use of TCM for treating CACS and the drug development. Copyright© by the Chinese Pharmaceutical Association.

Retrospective observational assessment of statin adherence among subjects patronizing different types of community pharmacies in Canada.

Science.gov (United States)

Evans, Charity D; Eurich, Dean T; Lamb, Darcy A; Taylor, Jeffrey G; Jorgenson, Derek J; Semchuk, William M; Mansell, Kerry D; Blackburn, David F

2009-01-01

Community pharmacies vary widely in terms of ownership structures, location, and dispensing policies. It is unknown if an association exists between the type of community pharmacy and the degree of medication adherence exhibited by patrons-patients. To describe adherence to statin therapy among subjects patronizing different types of community pharmacy categories (department- mass merchandise, chain-franchise, and independent-banner) in Saskatchewan, Canada, between 2000 and 2005. Study data were obtained from the Saskatchewan Drug Plan and Extended Benefits database, which is maintained by the government of Saskatchewan, Canada. The study included all subjects who (a) filled a statin prescription within selected community pharmacies between January 1, 2000, and December 31, 2005; (b) had no record of statin prescriptions during the year prior to the first statin prescription, according to the records of the Saskatchewan Drug Plan and Extended Benefits; and (c) demonstrated active utilization in the drug plan database for at least 1 year after the first statin prescription. The proxy criterion for activity was any dispensing record for statin or nonstatin medications at least 1 year following the index claim. Statin adherence level was estimated as tablets per day, defined as the total number of tablets dispensed divided by the total number of days of observation. Each subject's observation period began on the index date and ended on the earlier of (a) 30 days after the last recorded fill for any type of prescription medication (statin or nonstatin), or (b) December 31, 2005. The primary end point was the proportion of subjects within each pharmacy category who maintained an adherence level of 80% or greater during their individual observation period. Additional adherence calculations were performed for each of 3 time periods, beginning on the index date and ending on days 365, 729, and 1094 (i.e., 1, 2, and 3 years). Patients were included in the analysis for each

21 CFR 1306.22 - Refilling of prescriptions.

Science.gov (United States)

2010-04-01

... 21 Food and Drugs 9 2010-04-01 2010-04-01 false Refilling of prescriptions. 1306.22 Section 1306.22 Food and Drugs DRUG ENFORCEMENT ADMINISTRATION, DEPARTMENT OF JUSTICE PRESCRIPTIONS Controlled... 75 FR 16308, Mar. 31, 2010, § 1306.22 was revised, effective June 1, 2010. For the convenience of the...

[Inappropriate prescription in older patients: the STOPP/START criteria].

LENUS (Irish Health Repository)

Delgado Silveira, Eva

2009-09-01

Older people are a heterogeneous group of patients, often with multiple comorbidities for which they are prescribed a large number of drugs, leading to an increased risk of adverse drug reactions (ADR) and drug interactions. This risk is compounded by physiological age-related changes in physiology, changes in drug pharmacokinetics and pharmacodynamics, as well as by disease-related, functional and social issues. Inappropriate prescription of drugs is common in the older individuals and contributes to the increased risk of ADR. Several tools have been developed to detect potentially inappropriate prescription, the most frequently used in Spain being Beers\\' criteria. However, the value of these criteria is limited, especially as they were developed in a different healthcare system. In this article, the Spanish version of a new tool to detect potentially inappropriate prescriptions-STOPP (Screening Tool of Older Person\\'s Prescriptions) and START (Screening Tool to Alert doctors to Right i.e. appropriate, indicated Treatment) criteria-is presented. The creation, development, reliability, and use of these criteria in routine practice is described and discussed. These criteria have shown better sensitivity than Beers\\' criteria in detecting prescription problems and have the added value of being able to detect not only inappropriate prescription of some drugs, but also the omission of well indicated drugs. The STOPP\\/START criteria could become a useful screening tool to improve prescription in older people.

Prescription Drug Monitoring Programs and Other Interventions to Combat Prescription Opioid Abuse

Directory of Open Access Journals (Sweden)

Bharath Chakravarthy

2012-12-01

Full Text Available The Center for Disease Control and Prevention (CDC has published significant data and trendsrelated to opioid prescription pain relievers (OPR. In 2008, 20,044 deaths were attributedto prescription drug overdose of which 14,800 (73.8% were due to OPR, an amount greaterthan the number of overdose deaths from heroin and cocaine combined. The majority of thesedeaths were unintentional. Between 1999-2008, overdose deaths from OPR increased almostfour-fold. Correspondingly, sales of OPR were four times greater in 2010 than in 1999. Mostsignificant to emergency physicians is the estimate that 39% of all opioids prescribed, administeredor continued come from the emergency department (ED. We present findings from theCDC’s Morbidity and Mortality Weekly Report (MMWR with commentary on current recommendationsand policies for curtailing the OPR epidemic.1

Second WCB claims: who is at risk?

Science.gov (United States)

Cherry, Nicola M; Sithole, Fortune; Beach, Jeremy R; Burstyn, Igor

2010-01-01

Many workers with one Workers' Compensation Board (WCB) claim make further claims. If the characteristics of the job, initial injury or worker were predictive of an early second claim, interventions at the time of return to work after the first claim might be effective in reducing the burden of work-related injury. This report explores the characteristic of those who make a second claim. Records of all Alberta WCB claims from January 1, 1995, to December 31, 2004, for individuals 18 to claim, sex and age of claimant, type of injury, type of accident, occupation, industry, an indicator of company size, and industry claim rate were extracted, as well as the date of any second claim. The likelihood of second claim and mean time to second claim were estimated. Multivariate analyses were performed using Cox regression. 1,047,828 claims were identified from 490,230 individuals. Of these, 49.2% had at least two claims. In the multivariate model a reduced time to second claim was associated with male sex, younger age and some types of injury and accident. Machining trades were at highest risk of early second claim (hazard ratio [HR] 2.54 compared with administration), and of the industry sectors manufacturing was at highest risk (HR 1.37 compared with business, personal and professional services). Some caution is needed in interpreting these data as they may be affected by under-reporting and job changes between claims. Nonetheless, they suggest that there remains room for interventions to reduce the considerable differences in risk of a second claim among workers, jobs and industries.

Workers Compensation Claim Data -

Data.gov (United States)

Department of Transportation — This data set contains DOT employee workers compensation claim data for current and past DOT employees. Types of data include claim data consisting of PII data (SSN,...

32 CFR 842.110 - Claims not payable.

Science.gov (United States)

2010-07-01

...) Claims for a maritime occurrence covered under U.S. admiralty laws. (o) Claims for: (1) Any tax or... International Agreements Claims Act. (4) The Air Force Admiralty Claims Act and the Admiralty Extensions Act. (5...) Claims from the combat activities of the armed forces during war or armed conflict. (c) Claims for...

A Theoretical Approach to Electronic Prescription System: Lesson Learned from Literature Review

Science.gov (United States)

Samadbeik, Mahnaz; Ahmadi, Maryam; Hosseini Asanjan, Seyed Masoud

2013-01-01

Context The tendency to use advanced technology in healthcare and the governmental policies have put forward electronic prescription. Electronic prescription is considered as the main solution to overcome the major drawbacks of the paper-based medication prescription, such as transcription errors. This study aims to provide practical information concerning electronic prescription system to a variety of stakeholders. Evidence Acquisition In this review study, PubMed, ISI Web of Science, Scopus, EMBASE databases, Iranian National Library Of Medicine (INLM) portal, Google Scholar, Google and Yahoo were searched for relevant English publications concerning the problems of paper-based prescription, and concept, features, levels, benefits, stakeholders and standards of electronic prescription system. Results There are many problems with the paper prescription system which, according to studies have jeopardized patients’ safety and negatively affected the outcomes of medication therapy. All of these problems are remedied through the implementation of e-prescriptions. Conclusions The sophistication of electronic prescription and integration with EHR will become a reality, if all its stakeholders collaborate in developing fast and secure electronic prescription systems. It is plausible that the required infrastructure should be provided for implementation of the national integrated electronic prescription systems in countries without the system. Given the barriers to the implementation and use, policymakers should consider multiple strategies and offer incentives to encourage e-prescription initiatives. This will result in widespread adoption of the system. PMID:24693376

The mental health consequences of nonmedical prescription drug use among adolescents.

Science.gov (United States)

Ali, Mir M; Dean, David; Lipari, Rachel; Dowd, William N; Aldridge, Arnie P; Novak, Scott P

2015-03-01

Nonmedical prescription drug use is estimated to be the second most abused category of drugs after marijuana among adolescents. Prescription drugs can be highly addictive and prolonged use can produce neurological changes and physiological dependence and could result in adverse mental health outcomes. This topic is largely unexplored, as current knowledge of possible mechanisms of the linkage between adverse mental health consequences and prescription drug misuse is limited. This study explores the relationship between nonmedical use of prescription drugs and depression outcomes among adolescents. Given their complex and confounded relationship, our purpose is to better understand the extent to which nonmedical use of prescription drugs is an antecedent of depressive episodes. Using data from the 2008-2012 National Survey on Drug Use and Health, the study employs a propensity score matching methodology to ascertain whether nonmedical use of prescription drugs is linked to major depressive episodes among adolescents. The results document a positive relationship between nonmedical prescription drug use and major depressive episodes among adolescents. Specifically, the results indicate that adolescents who used prescription drugs non-medically are 33% to 35% more likely to experience major depressive episodes compared to their non-abusing counterparts. This provides additional evidence about the potential public health consequences of misuse of prescription drugs on adverse mental health outcomes. Given the significant increased risk of major depressive episode among adolescents who use prescription drugs nonmedically, it seems that the prevention of nonmedical prescription drug use warrants the utilization of both educational and public health resources. An important area for future research is to understand how any policy initiatives in this area must strike a balance between the need to minimize the misuse of prescription drugs and the need to ensure access for

Emergency department discharge prescription interventions by emergency medicine pharmacists.

Science.gov (United States)

Cesarz, Joseph L; Steffenhagen, Aaron L; Svenson, James; Hamedani, Azita G

2013-02-01

We determine the rate and details of interventions associated with emergency medicine pharmacist review of discharge prescriptions for patients discharged from the emergency department (ED). Additionally, we evaluate care providers' satisfaction with such services provided by emergency medicine pharmacists. This was a prospective observational study in the ED of an academic medical center that serves both adult and pediatric patients. Details of emergency medicine pharmacist interventions on discharge prescriptions were compiled with a standardized form. Interventions were categorized as error prevention or optimization of therapy. The staff of the ED was surveyed related to the influence and satisfaction of this new emergency medicine pharmacist-provided service. The 674 discharge prescriptions reviewed by emergency medicine pharmacists during the study period included 602 (89.3%) for adult patients and 72 (10.7%) for pediatric patients. Emergency medicine pharmacists intervened on 68 prescriptions, resulting in an intervention rate of 10.1% (95% confidence interval [CI] 8.0% to 12.7%). The intervention rate was 8.5% (95% CI 6.4% to 11.1%) for adult prescriptions and 23.6% for pediatric prescriptions (95% CI 14.7% to 35.3%) (difference 15.1%; 95% CI 5.1% to 25.2%). There were a similar number of interventions categorized as error prevention and optimization of medication therapy, 37 (54%) and 31 (46%), respectively. More than 95% of survey respondents believed that the new pharmacist services improved patient safety, optimized medication regimens, and improved patient satisfaction. Emergency medicine pharmacist review of discharge prescriptions for discharged ED patients has the potential to significantly improve patient care associated with suboptimal prescriptions and is highly valued by ED care providers. Copyright © 2012. Published by Mosby, Inc.

Doctor Shopping Behavior and the Diversion of Prescription Opioids.

Science.gov (United States)

Simeone, Ronald

2017-01-01

"Doctor shopping" as a means of prescription opioid diversion is examined. The number and percentage of prescriptions and morphine-equivalent milligrams diverted in this manner are estimated by state and molecule for the period 2008-2012. Eleven billion prescriptions with unique patient, doctor, and pharmacy identifiers were used to construct diversion "events" that involved between 1 and 6 unique doctors and between 1 and 6 unique pharmacies. Diversion thresholds were established based on the probability of each contingency. A geographically widespread decline occurred between 2008 and 2012. The number of prescriptions diverted fell from approximately 4.30 million (1.75% of all prescriptions) in 2008 to approximately 3.37 million (1.27% of all prescriptions) in 2012, and the number of morphine-equivalent milligrams fell from approximately 6.55 metric tons (2.95% of total metric tons) in 2008 to approximately 4.87 metric tons (2.19% of total metric tons) in 2012. Diversion control efforts have likely been effective. But given increases in opioid-related deaths, opioid-related drug treatment admissions, and the more specific resurgence of heroin-related events, it is clear that additional public health measures are required.

An audit of dental prescriptions between clinics and dental laboratories.

Science.gov (United States)

Stewart, C A

2011-08-12

To discover the quality of written instructions from dentists to dental technicians and the nature of non-compliant prescriptions. An audit of laboratory prescription compliance was conducted within an NHS Trust Dental Teaching Hospital to determine the level of communication between dentists and dental technicians. One hundred and fifty prescriptions were audited from dental undergraduates and qualified dentists throughout the different departments. A total of two-thirds of prescriptions were considered non-compliant and failed to meet relevant ethical and legal guidelines. This problem was seen throughout all departments and at all professional levels. A breakdown in communication between dentists and technicians through the use of prescriptions is evident even within a close working environment.

IBO Claim Taking Project

Data.gov (United States)

Social Security Administration — IBO manually tracks all Canadian Claims and DSU claims via this report. It also provides a summary for each region and office of origin that the DSU works with. This...

A retrospective study of daptomycin use in a Paris teaching-hospital.

Science.gov (United States)

Marc, F; Esquirol, C; Papy, E; Longuet, P; Armand-Lefevre, L; Rioux, C; Diamantis, S; Dumortier, C; Bourgeois-Nicolaos, N; Lucet, J-C; Wolff, M; Arnaud, P

2014-01-01

We retrospectively studied daptomycin use during 2010 at the Bichat-Claude-Bernard teaching-hospital (Paris) to observe the evolution of daptomycin prescriptions. Twenty-one patients were included and several parameters were documented: site of infection, bacterial species involved, reason for daptomycin use, dose and clinical outcome. Ninety-five percent of daptomycin prescritions were off-label and most did not comply with local guidelines. Fifteen of the 21 patients were cured (71%), including 9 patients of the 12 with off-label and off-local recommendation prescriptions (75%). Osteitis and Enterococcus spp endocarditis were the new indications. Daptomycin was increasingly used at higher doses: 52% of our patients were given doses above 6mg/kg. Staphylococcus spp. was the most frequent pathogen responsible for infection is our patients, followed by Enterococcus spp. Daptomycin use is likely to evolve because of its effectiveness in the treatment of osteitis, left-sided and Enterococcus spp. infective endocarditis. It is generally used at higher doses, which are well tolerated. However, therapeutic monitoring needs to be developed. The antibiotic commission of our hospital gave new recommendations for daptomycin use in 2011. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Towards Prescriptive Analytics in Cyber-Physical Systems

DEFF Research Database (Denmark)

Siksnys, Laurynas

solving capability allowing to formulate optimization problems using SQL-like queries and to solve them “inside a database”, (4) a real-time data management architecture for processing instances of flexibility and prescription models under (soft or hard) timing constraints, and (5) a graphical user...... of (1) a unified multi-dimensional schema for storing flexibility and prescription models (and related data), (2) techniques to incrementally aggregate flexibility model instances and disaggregate prescription model instances, (3) a database management system (DBMS) with built-in optimization problem...... the introduced concepts are applicable in the real world. We believe that all this contribution makes a significant step towards developing planning-capable CPSs in the future....

Prescription Drug Abuse

Science.gov (United States)

... were prescribed to someone else or if your child is already taking other prescription medications. Set rules. Let your teen know that it's not OK to share medications with others — or to take drugs prescribed for others. Emphasize the importance of taking the prescribed dose and talking with ...

Medicaid Drug Claims Statistics

Data.gov (United States)

U.S. Department of Health & Human Services — The Medicaid Drug Claims Statistics CD is a useful tool that conveniently breaks up Medicaid claim counts and separates them by quarter and includes an annual count.

Influence of pharmaceutical marketing on prescription practices of physicians.

Science.gov (United States)

Narendran, Roshni; Narendranathan, M

2013-01-01

In India same drug molecules are sold under different brand names by different pharmaceuticals. To persuade the physicians to prescribe their brands pharmaceuticals engage in marketing techniques like giving samples, gifts, sponsoring travel etc. Many countries are striving to reduce the impact of incentives on prescription behaviour. This study explores the influence of pharmaceutical marketing on the prescription practices of doctors in India. There were 103 study subjects - 50 doctors and 53 sales personnel. Data collection was done by a self administered questionnaire. Data were collected on 36 variables which were supposed to influence prescription. The effectiveness of the promotional strategies on prescription behaviour was marked in a seven point Likert scale ranging from "not at all effective" (score=1) to "extremely effective" (score=7). Open ended questions were used to collect qualitative data. Good rapport with the doctor, launch meetings, reputation of the company, quality of the drug and brand names significantly influenced prescription behaviour, while direct mailers, advertisements in journals and giving letter pads and other brand reminders were less effective. Commonly used method of giving samples was not among the twenty most effective methods influencing prescription. Product quality and good company are still factors that influence prescription. Pharmaceutical marketing influences the choice of brands by a physician. The more expensive strategies involved in public relations are more effective. Sending mails and journal advertisements are less effective strategies. How expensive marketing strategies affect cost of the medicines has to be explored further.

An Individual Claims History Simulation Machine

Directory of Open Access Journals (Sweden)

Andrea Gabrielli

2018-03-01

Full Text Available The aim of this project is to develop a stochastic simulation machine that generates individual claims histories of non-life insurance claims. This simulation machine is based on neural networks to incorporate individual claims feature information. We provide a fully calibrated stochastic scenario generator that is based on real non-life insurance data. This stochastic simulation machine allows everyone to simulate their own synthetic insurance portfolio of individual claims histories and back-test thier preferred claims reserving method.

Major surgery in south India: a retrospective audit of hospital claim data from a large community health insurance programme.

Science.gov (United States)

Shaikh, Maaz; Woodward, Mark; Rahimi, Kazem; Patel, Anushka; Rath, Santosh; MacMahon, Stephen; Jha, Vivekanand

2015-04-27

Information about use of major surgery in India is scarce. This study aims to bridge this gap by auditing hospital claims from the Rajiv Aarogyasri Community Health Insurance Scheme (RACHIS) that provides access to free tertiary care for major surgery through state-funded insurance to 68 million beneficiaries with limited household incomes-81% of population in states of Telangana and Andhra Pradesh (combined Human Development Index 0·485). Beneficiary households receive an annual coverage of INR 200 000 (US$3333) for admissions to any empanelled public or private hospital. Publicly available deidentified hospital claim data for all surgical procedures conducted between mid-2008 and mid-2012 were compiled across all 23 districts in Telangana and Andhra Pradesh. 677 332 surgical admissions (80% at private hospitals) were recorded at a mean annual rate of 259 per 100 000 beneficiaries (95% CI 235-283), excluding cataract and caesarean sections as these were not covered under the insurance programme. Men accounted for 56% of admissions. Injury was the most common cause for surgical admission (185 733; 27%) with surgical correction of long bone fractures being the most common procedure (144 997; 20%) identified in the audit. Diseases of digestive (110 922; 16%), genitourinary (82 505; 12%), and musculoskeletal system (70 053; 10%) were other leading causes for surgical admissions. Most hospital bed-days were used for injuries (584 days per 100 000 person years; 31%), digestive diseases (314 days; 17%), and musculoskeletal system (207 days; 11%), costing 19% (INR 4·4 billion), 13% (3·03 billion), and 11% (2·5 billion) of claims, respectively. Cardiovascular surgeries (53 023; 8%) alone accounted for 21% (INR 4·9 billion) of cost. Annual per capita cost of surgical claims was US$1·49 (95% CI 1·32-1·65). Our findings are limited to a population socioeconomically representative of India and other countries with low-income and middle

Higher third-generation cephalosporin prescription proportion is associated with lower probability of reducing carbapenem use: a nationwide retrospective study

Directory of Open Access Journals (Sweden)

Allison Muller

2018-01-01

Full Text Available Abstract Background The ongoing extended spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE pandemic has led to an increasing carbapenem use, requiring release of guidelines for carbapenem usage in France in late 2010. We sought to determine factors associated with changes in carbapenem use in intensive care units (ICUs, medical and surgical wards between 2009 and 2013. Methods This ward-level multicentre retrospective study was based on data from French antibiotic and multidrug-resistant bacteria surveillance networks in healthcare facilities. Antibiotic use was expressed in defined daily doses per 1000 patient-days. Factors associated with the reduction in carbapenem use (yes/no over the study period were determined from random-effects logistic regression model (493 wards nested within 259 healthcare facilities: ward characteristics (type, size…, ward antibiotic use (initial antibiotic use [i.e., consumption of a given antibiotic in 2009], initial antibiotic prescribing profile [i.e., proportion of a given antibiotic in the overall antibiotic consumption in 2009] and reduction in the use of a given antibiotic between 2009 and 2013 and regional ESBL-PE incidence rate in acute care settings in 2011. Results Over the study period, carbapenem consumption in ICUs (n = 85, medical (n = 227 and surgical wards (n = 181 was equal to 73.4, 6.2 and 5.4 defined daily doses per 1000 patient-days, respectively. Release of guidelines was followed by a significant decrease in carbapenem use within ICUs and medical wards, and a slowdown in use within surgical wards. The following factors were independently associated with a higher probability of reducing carbapenem use: location in Eastern France, higher initial carbapenem prescribing profile and reductions in consumption of fluoroquinolones, glycopeptides and piperacillin/tazobactam. In parallel, factors independently associated with a lower probability of reducing carbapenem use were

75 FR 12555 - Prescription Drug User Fee Act; Public Meeting

Science.gov (United States)

2010-03-16

...] Prescription Drug User Fee Act; Public Meeting AGENCY: Food and Drug Administration, HHS. ACTION: Notice of... Prescription Drug User Fee Act (PDUFA). The legislative authority for PDUFA expires in September 2012. At that time, new legislation will be required for FDA to continue collecting user fees for the prescription...

Antihypertensive use, prescription patterns, and cost of medications ...

African Journals Online (AJOL)

Antihypertensive use, prescription patterns, and cost of medications in a Teaching Hospital in Lagos, Nigeria. ... Conclusions: Antihypertensive prescription pattern was in accordance with the seventh report of Joint National Committee on Prevention, Detection, Evaluation, and Treatment of high blood pressure.

Tamper-resistant prescription forms for narcotics in France:should we generalise them?

Science.gov (United States)

Daveluy, Amélie; Sauvaget, Lucie; Bastien, Angela; Lapeyre-Mestre, Maryse; Collin, Cédric; Richard, Nathalie; Haramburu, Françoise

2018-03-27

In France, prescription of narcotics must be written on a tamper-resistant prescription form with specific technical particularities. Dosage and daily dose of medicines shall be written out entirely in letters. These prescription forms are also mandatory for buprenorphine, clorazepate, clonazepam, tianeptine, buccal midazolam and zolpidem owing to traffic, abuse or diversion. In 2012, to assess the use of standard and tamper-resistant prescription forms and the acceptability of the generalization of the latter to all medicines, a national opinion survey was performed, with a postal questionnaire, within 3 randomized samples of 1,500 prescribers (physicians, dentists and midwives). Of the 403 participating prescribers (participation rate of 26.8%), 373 were physicians, 14 dentists and 16 midwives. Tamper-resistant prescription forms were used by 76.2% of prescribers, but only by 5.1% in a computerised version, whereas, for standard prescription forms, 61% used computer assisted prescription software. The main reason was the inability of the prescription software to print these forms or to respect the mandatory prescription rules for narcotics. Theft and falsification of prescriptions had ever occurred (working life). Most prescribers (62.5%) were against the generalization of tamper-resistant prescription forms. Those in favour were for a generalization to all medicines (65%) and not only to psychotropic agents. Generalization of tamper-resistant prescription forms is not a consensual solution to prevent medicines' diversion. Some prescribers alluded to the possibility of dematerialisation and electronic transmission of prescription forms, which could avoid theft, forgery or falsification. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

37 CFR 360.25 - Copies of claims.

Science.gov (United States)

2010-07-01

... Section 360.25 Patents, Trademarks, and Copyrights COPYRIGHT ROYALTY BOARD, LIBRARY OF CONGRESS SUBMISSION OF ROYALTY CLAIMS FILING OF CLAIMS TO ROYALTY FEES COLLECTED UNDER COMPULSORY LICENSE Digital Audio Recording Devices and Media Royalty Claims § 360.25 Copies of claims. A claimant shall, for each claim...

32 CFR 842.94 - Assertable claims.

Science.gov (United States)

2010-07-01

..., against a tort-feasor when: (a) Damage results from negligence and the claim is for: (1) More than $100... ADMINISTRATIVE CLAIMS Property Damage Tort Claims in Favor of the United States (31 U.S.C. 3701, 3711-3719) § 842.... (The two claims should be consolidated and processed under subpart N). (d) The Tort-feasor or his...

Detection and correction of prescription errors by an emergency department pharmacy service.

Science.gov (United States)

Stasiak, Philip; Afilalo, Marc; Castelino, Tanya; Xue, Xiaoqing; Colacone, Antoinette; Soucy, Nathalie; Dankoff, Jerrald

2014-05-01

Emergency departments (EDs) are recognized as a high-risk setting for prescription errors. Pharmacist involvement may be important in reviewing prescriptions to identify and correct errors. The objectives of this study were to describe the frequency and type of prescription errors detected by pharmacists in EDs, determine the proportion of errors that could be corrected, and identify factors associated with prescription errors. This prospective observational study was conducted in a tertiary care teaching ED on 25 consecutive weekdays. Pharmacists reviewed all documented prescriptions and flagged and corrected errors for patients in the ED. We collected information on patient demographics, details on prescription errors, and the pharmacists' recommendations. A total of 3,136 ED prescriptions were reviewed. The proportion of prescriptions in which a pharmacist identified an error was 3.2% (99 of 3,136; 95% confidence interval [CI] 2.5-3.8). The types of identified errors were wrong dose (28 of 99, 28.3%), incomplete prescription (27 of 99, 27.3%), wrong frequency (15 of 99, 15.2%), wrong drug (11 of 99, 11.1%), wrong route (1 of 99, 1.0%), and other (17 of 99, 17.2%). The pharmacy service intervened and corrected 78 (78 of 99, 78.8%) errors. Factors associated with prescription errors were patient age over 65 (odds ratio [OR] 2.34; 95% CI 1.32-4.13), prescriptions with more than one medication (OR 5.03; 95% CI 2.54-9.96), and those written by emergency medicine residents compared to attending emergency physicians (OR 2.21, 95% CI 1.18-4.14). Pharmacists in a tertiary ED are able to correct the majority of prescriptions in which they find errors. Errors are more likely to be identified in prescriptions written for older patients, those containing multiple medication orders, and those prescribed by emergency residents.

Drug interactions between common illicit drugs and prescription therapies.

Science.gov (United States)

Lindsey, Wesley T; Stewart, David; Childress, Darrell

2012-07-01

The aim was to summarize the clinical literature on interactions between common illicit drugs and prescription therapies. Medline, Iowa Drug Information Service, International Pharmaceutical Abstracts, EBSCO Academic Search Premier, and Google Scholar were searched from date of origin of database to March 2011. Search terms were cocaine, marijuana, cannabis, methamphetamine, amphetamine, ecstasy, N-methyl-3,4-methylenedioxymethamphetamine, methylenedioxymethamphetamine, heroin, gamma-hydroxybutyrate, sodium oxybate, and combined with interactions, drug interactions, and drug-drug interactions. This review focuses on established clinical evidence. All applicable full-text English language articles and abstracts found were evaluated and included in the review as appropriate. The interactions of illicit drugs with prescription therapies have the ability to potentiate or attenuate the effects of both the illicit agent and/or the prescription therapeutic agent, which can lead to toxic effects or a reduction in the prescription agent's therapeutic activity. Most texts and databases focus on theoretical or probable interactions due to the kinetic properties of the drugs and do not fully explore the pharmacodynamic and clinical implications of these interactions. Clinical trials with coadministration of illicit drugs and prescription drugs are discussed along with case reports that demonstrate a potential interaction between agents. The illicit drugs discussed are cocaine, marijuana, amphetamines, methylenedioxymethamphetamine, heroin, and sodium oxybate. Although the use of illicit drugs is widespread, there are little experimental or clinical data regarding the effects of these agents on common prescription therapies. Potential drug interactions between illicit drugs and prescription drugs are described and evaluated on the Drug Interaction Probability Scale by Horn and Hansten.

Evaluation of Patient Migration Patterns and Related Health Care Costs Within a National Medicare Advantage Prescription Drug Plan After Implementation of an Oxycodone HCl Extended-Release Access Restriction.

Science.gov (United States)

Chen, Chi-Chang; De, Ajita P; Sweet, Brian; Wade, Rolin L

2017-08-01

Health plans use formulary restrictions (e.g., prior authorization, step therapy, tier change, nonformulary status) in an effort to control cost and promote quality, safety, and appropriate prescription utilization. Some Medicare payers perceive that the inclusion of certain agents, such as branded oxycodone HCl extended-release tablets (OERs), on their formularies is associated with attracting high-cost members to the plan. To evaluate disenrollment rates, patient migration, and subsequent health care costs among OER users who disenrolled from a national Medicare Advantage Prescription Drug plan (study-MAPD) in the plan year following OER nonformulary restriction. A retrospective, longitudinal cohort study using IMS pharmacy and medical claims data between July 1, 2011, and December 31, 2014, was conducted. In the study-MAPD, adults aged ≥ 18 years who were chronic OER users with ≥ 2 OER claims 6 months before the nonformulary restriction date on January 1, 2013 (index date) and with continuous activity in pharmacy and medical claims for 6 months pre- and post-index were included in the study. Comparison years of 2012 and 2014 prerestriction/postrestriction were selected. All groups were followed for 6 months postindex. Year-to-year disenrollment rates of OER patients and the overall plan, as well as patient characteristics and costs of those who disenrolled from and those who remained with the plan, were measured. Costs were compared using a difference-in-differences approach. This study identified 2,935 eligible OER users from the study-MAPD population after imposing nonformulary restrictions on OERs on January 1, 2013. Mean age was 62.1 years, and 59.8% were female. The mean Charlson Comorbidity Index score was 1.83 for those 1,001 patients with medical claims data. For comparison years 2012 (prerestriction) and 2014 (postrestriction), 2,248 and 2,222 OER patients were identified, respectively. Patient characteristics were similar across patient cohorts in

Impact of a Comprehensive Workplace Hand Hygiene Program on Employer Health Care Insurance Claims and Costs, Absenteeism, and Employee Perceptions and Practices.

Science.gov (United States)

Arbogast, James W; Moore-Schiltz, Laura; Jarvis, William R; Harpster-Hagen, Amanda; Hughes, Jillian; Parker, Albert

2016-06-01

The aim of this study was to determine the efficacy of a multimodal hand hygiene intervention program in reducing health care insurance claims for hygiene preventable infections (eg, cold and influenza), absenteeism, and subjective impact on employees. A 13.5-month prospective, randomized cluster controlled trial was executed with alcohol-based hand sanitizer in strategic workplace locations and personal use (intervention group) and brief hand hygiene education (both groups). Four years of retrospective data were collected for all participants. Hygiene-preventable health care claims were significantly reduced in the intervention group by over 20% (P Employee survey data showed significant improvements in hand hygiene behavior and perception of company concern for employee well-being. Providing a comprehensive, targeted, yet simple to execute hand hygiene program significantly reduced the incidence of health care claims and increased employee workplace satisfaction.

42 CFR 423.159 - Electronic prescription drug program.

Science.gov (United States)

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Electronic prescription drug program. 423.159 Section 423.159 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT Cost Control and Quality...

76 FR 59898 - Branded Prescription Drug Fee; Correction

Science.gov (United States)

2011-09-28

... Branded Prescription Drug Fee; Correction AGENCY: Internal Revenue Service (IRS), Treasury. ACTION... Register on Thursday, August 18, 2011. The proposed regulation provides guidance relating to the branded... as follows: 1. On Page 51311, column 2, under the part heading PART 51--BRANDED PRESCRIPTION DRUGS...

Prescription for herbal healing

National Research Council Canada - National Science Library

Balch, Phyllis A; Bell, Stacey J

2012-01-01

.... From the most trusted name in natural healing, Phyllis A. Balch's new edition of Prescription for Herbal Healing provides the most current research and comprehensive facts in an easy-to-read A- to-Z format, including...

Management of type 2 diabetes and its prescription drug cost before and during the economic crisis in Greece: an observational study.

Science.gov (United States)

Liatis, Stavros; Papaoikonomou, Stavroula; Ganotopoulou, Asimina; Papazafiropoulou, Athanasia; Dinos, Constantinos; Michail, Marios; Xilomenos, Apostolos; Melidonis, Andreas; Pappas, Stavros

2014-03-05

The aim of the present study is to examine the clinical indices related to cardiovascular risk management of Greek patients with type 2 diabetes, before and after the major economic crisis that emerged in the country. In this retrospective database study, the medical records of patients with type 2 diabetes treated at three diabetes outpatient centers of the national health system during 2006 and 2012 were examined. Only patients with at least six months of follow-up prior to the recorded examination were included. The prescription cost was calculated in Euros per patient-year (€PY). A total of 1953 medical records (938 from 2006 and 1015 from 2012) were included. There were no significant differences in adjusted HbA1c, systolic blood pressure and HDL-C, while significant reductions were observed in LDL-C and triglycerides. In 2012, a higher proportion of patients were prescribed glucose-lowering, lipid-lowering and antihypertensive medications. Almost 4 out of 10 patients were prescribed the new incretin-based medications, while the use of older drugs, except for metformin, decreased. A significant increase in the adjusted glucose-lowering prescription cost (612.4 [586.5-638.2] €PY vs 390.7 [363.5-418.0]; p crisis, the cardiovascular risk indices of Greek patients with type 2 diabetes being followed in public outpatient diabetes clinics did not deteriorate and in the case of lipid profile improved. However, the total prescription cost increased, mainly due to the higher cost of glucose-lowering prescriptions.

A model of the prescription-pharmaceutical sales process

Directory of Open Access Journals (Sweden)

Michael Stros

2018-06-01

Full Text Available The purpose of this paper is to determine the factors in marketing most relevant to achieving pharmaceutical sales success and their interrelations, as well as providing a prescription-pharmaceuticals sales process model. This will enable scholars to obtain a better understanding of the marketing process for prescription pharmaceuticals, as well as enabling marketers to apply more efficient marketing approaches. The study uses a unique data set, combining primary data and secondary data from the Swiss prescription-pharmaceuticals market. The data is analysed using a multiple-regression based model. A multi-level data structure is found, suggesting that factors concerning the specific brand and also the pharmaceutical substance itself are relevant to sales success. It is revealed that the factors most relevant to sales success are: order of market entry, perceived product-quality, average price, and marketing expenditures, leading to practical recommendations for scholars and marketing professionals. The study focuses only on the Swiss prescription-pharmaceuticals market, investigating five medical drug classes. The assumption is made that these results can be generalised to similar markets and drug classes. The study develops a conceptual prescription-pharmaceuticals sales-process model; offers practical guidelines and a good basis for further scholarly research are provided; and identifies several research gaps by giving proposals for future research.

Off-label prescriptions in diabetic foot

Directory of Open Access Journals (Sweden)

Luís Jesuíno de Oliveira Andrade

2014-09-01

Full Text Available Prescription of a drug outside of the indications for which it was originally approved by regulators is internationally known as "off-label" prescription. We describe off-label treatments for the diabetic foot reported in international scientific literature. This is a qualitative and descriptive bibliographical review based on the results of a search of the Medline international database. The criteria for review were publication between January 1985 and November 2013, and the MeSH (Medical Subject Heading keywords "off-label use" OR "off-label" OR "off-label prescribing" plus "diabetic foot" were input on the search form. Nine studies were selected that contained information about off-label treatments for the diabetic foot. We conclude that the practice of off-label prescribing has potential benefits. In some situations an off-label prescription is the only treatment available for patients, either because a more targeted drug does not exist, or because other methods of treatment are ineffective or unavailable due to patient intolerance.

Quality and Variability of Patient Directions in Electronic Prescriptions in the Ambulatory Care Setting.

Science.gov (United States)

Yang, Yuze; Ward-Charlerie, Stacy; Dhavle, Ajit A; Rupp, Michael T; Green, James

2018-01-18

The prescriber's directions to the patient (Sig) are one of the most quality-sensitive components of a prescription order. Owing to their free-text format, the Sig data that are transmitted in electronic prescriptions (e-prescriptions) have the potential to produce interpretation challenges at receiving pharmacies that may threaten patient safety and also negatively affect medication labeling and patient counseling. Ensuring that all data transmitted in the e-prescription are complete and unambiguous is essential for minimizing disruptions in workflow at prescribers' offices and receiving pharmacies and optimizing the safety and effectiveness of patient care. To (a) assess the quality and variability of free-text Sig strings in ambulatory e-prescriptions and (b) propose best-practice recommendations to improve the use of this quality-sensitive field. A retrospective qualitative analysis was performed on a nationally representative sample of 25,000 e-prescriptions issued by 22,152 community-based prescribers across the United States using 501 electronic health records (EHRs) or e-prescribing software applications. The content of Sig text strings in e-prescriptions was classified according to a Sig classification scheme developed with guidance from an expert advisory panel. The Sig text strings were also analyzed for quality-related events (QREs). For purposes of this analysis, QREs were defined as Sig text content that could impair accurate and unambiguous interpretation by staff at receiving pharmacies. A total of 3,797 unique Sig concepts were identified in the 25,000 Sig text strings analyzed; more than 50% of all Sigs could be categorized into 25 unique Sig concepts. Even Sig strings that expressed apparently simple and straightforward concepts displayed substantial variability; for example, the sample contained 832 permutations of words and phrases used to convey the Sig concept of "Take 1 tablet by mouth once daily." Approximately 10% of Sigs contained QREs

Retrospective drug utilization review: impact of pharmacist interventions on physician prescribing

Directory of Open Access Journals (Sweden)

Angalakuditi M

2011-06-01

Full Text Available Mallik Angalakuditi1, Joseph Gomes21Georgia State University, Atlanta, GA, USA; 2Baxter Health Care, Deerfield, IL, USAObjectives: To evaluate the impact of retrospective drug utilization review (RDUR, pharmacist’s interventions on physician prescribing, and the level of spillover effect on future prescriptions following the intervention.Methods: A retrospective case–control study was conducted at a pharmacy benefits management company using the available prescription data from April 2004 to August 2005. RDUR conflicts evaluated and intervened by a clinical pharmacist served as a case group, whereas conflicts that were not evaluated and intervened by a clinical pharmacist served as a control group.Results: A total of 40,284 conflicts in cases and 13,044 in controls were identified. For cases, 32,780 interventions were considered nonrepetitive, and 529 were repetitive. There were 22,870 physicians in cases that received intervention letters and 2348 physicians in the control group that would have received intervention letters during the study period. Each physician received on average 1.4 interventions for cases vs 3.0 for controls. Among the case physicians who were intervened during the study period, 2.2% (505 were involved in a repeated intervention vs 18.2% (428 in controls (P < 0.001, which is an eight-fold difference. The most common conflict intervened on in cases was therapeutic appropriateness (8277, 25.3%, and for controls it was drug–drug interactions (1796, 25.4%. The overall interventional spillover effect in cases was 98.4% vs 89.4% in controls (P = 0.01.Conclusion: RDUR is an effective interventional program which results in decreased numbers of interventions per physician and provides a significant impact on future prescribing habits.Keywords: pharmacy management, spillover effect, RDUR, DUR

Assessing the appropriateness of parenteral nutrition use in hospitalized patients. A comparison on parenteral nutrition bag prescription in different wards and nutritional outcomes.

Science.gov (United States)

Ponta, Monica Laura; Rabbione, Laura; Borgio, Cristina; Quirico, Eliana; Patrito, Elena; Petrachi, Maria Novella; Girotto, Elisabetta; Sillano, Marisa; Geninatti, Silvio; Zanardi, Michela; Pezzana, Andrea

2018-06-01

Our aim is to assess parenteral nutrition (PN) bag prescription in hospitalized patients and evaluate clinical outcomes linked to PN therapy. We performed an observational longitudinal retrospective study on PN prescription in a General Public Hospital in Turin, Italy, on ninety-five patients receiving PN prescribed by the Nutrition Support Team (NST). We described patients' demography and assessed nutritional outcomes, as well as PN bag prescription in different wards. Medians were calculated for several clinical parameters before and after PN therapy. A z-test for proportions has been performed to better understand the impact of various conditions on clinical outcomes and to compare differences between administered nutrients and required amounts. The NST resulted responsible for only 18% of bags prescribed in the geriatrics ward and for 48% in the surgery wards. PN was not able to fulfill nutritional requirements resulting in a median lack of 3.1 calories and 0.23 g of proteins per kilogram of reference body weight per day. Despite this, PN therapy was able to improve total blood proteins and calcium blood levels in our cohort. The NST changed the prescription in 55.8% of the pre-existing PN regimens. More strict adherence to guidelines is needed in order to maximize effectiveness of PN and observe a positive impact on clinical parameters. Copyright © 2018 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.

Income and the use of prescription drugs for near retirement individuals

DEFF Research Database (Denmark)

Leth-Petersen, Søren; Skipper, Niels

Understanding how demand for prescription drugs responds to changes in income is important for assessing the welfare consequences of reforms affecting income. This becomes more imminent as age progresses, because the use of prescription drugs and the associated budgetary burden increases dramatic......Understanding how demand for prescription drugs responds to changes in income is important for assessing the welfare consequences of reforms affecting income. This becomes more imminent as age progresses, because the use of prescription drugs and the associated budgetary burden increases...... dramatically from about age 55. In this paper we estimate how demand for prescription drugs varies with income for a sample of near retirement individuals. Estimating the prescription drug demand response to income changes is complicated because an important explanatory variable, the health capital......, is unobserved, and because demand is potentially dynamic, for example because some drugs are habitual. The analysis is based on a novel panel data set with information about purchase of prescription drug demand for a very large number of Danish individuals over the period 1995-2003. Our preferred model...

Direct-to-consumer prescription drug advertising: history, regulation, and issues.

Science.gov (United States)

Huh, Jisu; DeLorme, Denise E; Reid, Leonard N; An, Soontae

2010-03-01

Direct-to-consumer advertising has changed the way prescription drugs are marketed in the United States. This article traces the history of direct-to-consumer advertising of prescription and over-the-counter medications and describes how drug advertising is regulated and by whom. It also discusses the controversies that surround direct-to-consumer marketing of prescription drugs.

Do Motives Matter?: Nonmedical Use of Prescription Medications among Adolescents

Science.gov (United States)

McCabe, Sean Esteban; Boyd, Carol J.

2012-01-01

Adolescents' motives for engaging in nonmedical prescription drug use is somewhat different than their reasons for using other drugs, such as marijuana. For some youth, nonmedical prescription drug use is an attempt to self-treat a medical condition, for others it is an effort to get high, and some youth misuse prescription drugs for both reasons.…

Illegal "no prescription" internet access to narrow therapeutic index drugs.

Science.gov (United States)

Liang, Bryan A; Mackey, Tim K; Lovett, Kimberly M

2013-05-01

Narrow therapeutic index (NTI) drugs, because of proximity of therapeutic amounts to toxic amounts, require close professional oversight, particularly when switching formulations. However, safe use may be compromised by unsupervised switching through access to online "no prescription" Web sites. We assessed no prescription online availability of NTI drugs, using an academically published list (core NTI drugs). Using the Google search term "buy DRUG no prescription," we reviewed the first 5 search result pages for marketing of no prescription NTI drugs. We further assessed if National Association of Boards of Pharmacy (NABP) Not Recommended vendors were marketing NTI drugs. Searches were conducted from November 3, 2012 to January 3, 2013. For core NTI drugs, we found 13 of 14 NTI drugs (92%) marketed as available without prescription, all from NABP Not Recommended vendors. On the basis of these initial findings, we expanded our core list to 12 additional NTI drugs; 11 of 12 of these drugs (92%) were available from no prescription Web sites. Overall, 24 of 26 NTI drugs (92%) were illegally marketed as available online without the need for a prescription. Suspect online NTI drug access from no prescription vendors represents a significant patient safety risk because of potential patient drug switching and risk of counterfeit versions. Further, state health care exchanges with coverage limitations may drive patients to seek formulations online. Food and Drug Administration harmonization with tighter international NTI drug standards should be considered, and aggressive action against suspect online marketers should be a regulatory and public health priority. Copyright © 2013 Elsevier HS Journals, Inc. All rights reserved.

77 FR 46653 - Branded Prescription Drug Fee; Hearing

Science.gov (United States)

2012-08-06

... DEPARTMENT OF THE TREASURY Internal Revenue Service 26 CFR Part 51 [REG-112805-10] RIN 1545-BJ39 Branded Prescription Drug Fee; Hearing AGENCY: Internal Revenue Service (IRS), Treasury. ACTION: Notice of... document provides notice of public hearing on proposed regulations relating to the branded prescription...

Prosthetic prescription in the Netherlands : an observational study

NARCIS (Netherlands)

van der Linde, H; Geertzen, JHB; Hofstad, CJ; Postema, K; Van Limbeek, Jacques

2003-01-01

Prosthetic prescription for lower limb amputees and the methodology used are primarily based on empirical knowledge. Clinical expertise plays an important role that can lead to an adequate prescription; however, a clear evidence based motivation for the choices made cannot be given. This can lead to

Prescription, dispensation and marketing patterns of methylphenidate

Directory of Open Access Journals (Sweden)

Edson Perini

2014-12-01

Full Text Available OBJECTIVE To analyze the patterns and legal requirements of methylphenidate consumption. METHODS We conducted a cross-sectional study of the data from prescription notification forms and balance lists of drugs sales – psychoactive and others – subject to special control in the fifth largest city of Brazil, in 2006. We determined the defined and prescribed daily doses, the average prescription and dispensation periods, and the regional sales distribution in the municipality. In addition, we estimated the costs of drug acquisition and analyzed the individual drug consumption profile using the Lorenz curve. RESULTS The balance lists data covered all notified sales of the drug while data from prescription notification forms covered 50.6% of the pharmacies that sold it, including those with the highest sales volumes. Total methylphenidate consumption was 0.37 DDD/1,000 inhabitants/day. Sales were concentrated in more developed areas, and regular-release tablets were the most commonly prescribed pharmaceutical formulation. In some regions of the city, approximately 20.0% of the prescriptions and dispensation exceeded 30 mg/day and 30 days of treatment. CONCLUSIONS Methylphenidate was widely consumed in the municipality and mainly in the most developed areas. Of note, the consumption of formulations with the higher abuse risk was the most predominant. Both its prescription and dispensation contrasted with current pharmacotherapeutic recommendations and legal requirements. Therefore, the commercialization of methylphenidate should be monitored more closely, and its use in the treatment of behavioral changes of psychological disorders needs to be discussed in detail, in line with the concepts of the quality use of medicines.

Utilization of health services and prescription patterns among lupus patients followed by primary care physicians and rheumatologists in Puerto Rico.

Science.gov (United States)

Molina, María J; Mayor, Angel M; Franco, Alejandro E; Morell, Carlos A; López, Miguel A; Vilá, Luis M

2008-01-01

To examine the utilization of health services and prescription patterns among patients with systemic lupus erythematosus (SLE) followed by primary care physicians and rheumatologists in Puerto Rico. The insurance claims submitted by physicians to a health insurance company of Puerto Rico in 2003 were examined. The diagnosis of lupus was determined by using the International Classification of Diseases, Ninth Revision, code for SLE (710.0). Of 552,733 insured people, 665 SLE patients were seen by rheumatologists, and 92 were followed by primary care physicians. Demographic features, selected co-morbidities, healthcare utilization parameters, and prescription patterns were examined. Fisher exact test, chi2 test, and analysis of variances were used to evaluate differences between the study groups. SLE patients followed by rheumatologists had osteopenia/osteoporosis diagnosed more frequently than did patients followed by primary care physicians. The frequency of high blood pressure, diabetes mellitus, hypercholesterolemia, coronary artery disease, and renal disease was similar for both groups. Rheumatologists were more likely to order erythrocyte sedimentation rate, anti-dsDNA antibodies, and serum complements. No differences were observed for office or emergency room visits, hospitalizations, and utilization of routine laboratory tests. Rheumatologists prescribed hydroxychloroquine more frequently than did primary care physicians. The use of nonsteroidal anti-inflammatory drugs, cyclooxygenase-2 inhibitors, glucocorticoids, azathioprine, cyclophosphamide, and methotrexate was similar for both groups. Overall, the utilization of health services and prescription patterns among SLE patients followed by primary care physicians and rheumatologists in Puerto Rico are similar. However, rheumatologists ordered SLE biomarkers of disease activity and prescribed hydroxychloroquine more frequently than did primary care physicians.

A Retrospective Chart Review of Contraceptive Use among Adolescents with Opioid Use Disorder.

Science.gov (United States)

Handy, Caitlin J; Lange, Hannah L H; Manos, Brittny E; Berlan, Elise D; Bonny, Andrea E

2018-04-01

To describe contraceptive use among female adolescents initiating outpatient treatment for opioid use disorder. Retrospective chart review. Outpatient clinic providing medication-assisted treatment for substance use disorders to adolescents and young adults. Nonpregnant female adolescents who presented for treatment from January 1, 2013 to January 31, 2016 (N = 123). None. Prescription contraceptive use at baseline and initiation of a new method within 90 days. Of 123 female adolescents who presented for treatment of opioid use disorder, 113 (91.9%) reported sexual activity and 80 (65.0%) were not using prescription contraception at intake. Previous pregnancy was reported by 43 (35.0%) and 20 (16.3%) were positive for a sexually transmitted infection. Contraceptive counseling was not documented for 73 (59.3%) patients. Among patients with no prescription contraception at baseline, 56 of 80 (70.0%) initiated a method within the study window. Significant predictors (odds ratio [OR]; 95% confidence interval) of contraceptive initiation included previous pregnancy (8.6; 1.39-52.99), education of less than a high school diploma/general equivalency diploma (7.4; 1.63-33.41), and return for follow-up visit (9.8; 2.18-43.69). Young women who presented for opioid use disorder treatment were at high risk of adverse reproductive health outcomes. Most were sexually active and not using prescription contraception. Findings underscore the need for contraceptive counseling in this patient population. Optimally, these services would be provided in conjunction with substance use treatment. Improved contraceptive counseling documentation will allow evaluation of effective contraceptive counseling strategies for adolescents with opioid use disorders and might serve to inform future interventions. Copyright © 2017 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

Prescription medicine sharing experience among pharmacy students

OpenAIRE

Šliogerytė, Karolina

2017-01-01

K.Šliogeryte`s master thesis. Master thesis supervisor associate professor Jonas Grincevičius (2015/2016), lecturer J. Daukšienė(2016/2017); Lithuanian University of Health Sciences, Faculty of Pharmacy, Pharmaceutical technology and Social pharmacy department. – Kaunas. Master thesis: prescription medicine sharing experience among pharmacy students. The aim: to evaluate LUHS Pharmacy faculty students` experience in prescription drugs` sharing. Methods: empirical qualitative method...

Tuberculosis Prevention in the Private Sector: Using Claims-Based Methods to Identify and Evaluate Latent Tuberculosis Infection Treatment With Isoniazid Among the Commercially Insured.

Science.gov (United States)

Stockbridge, Erica L; Miller, Thaddeus L; Carlson, Erin K; Ho, Christine

Targeted identification and treatment of people with latent tuberculosis infection (LTBI) are key components of the US tuberculosis elimination strategy. Because of recent policy changes, some LTBI treatment may shift from public health departments to the private sector. To (1) develop methodology to estimate initiation and completion of treatment with isoniazid for LTBI using claims data, and (2) estimate treatment completion rates for isoniazid regimens from commercial insurance claims. Medical and pharmacy claims data representing insurance-paid services rendered and prescriptions filled between January 2011 and March 2015 were analyzed. Four million commercially insured individuals 0 to 64 years of age. Six-month and 9-month treatment completion rates for isoniazid LTBI regimens. There was an annual isoniazid LTBI treatment initiation rate of 12.5/100 000 insured persons. Of 1074 unique courses of treatment with isoniazid for which treatment completion could be assessed, almost half (46.3%; confidence interval, 43.3-49.3) completed 6 or more months of therapy. Of those, approximately half (48.9%; confidence interval, 44.5-53.3) completed 9 months or more. Claims data can be used to identify and evaluate LTBI treatment with isoniazid occurring in the commercial sector. Completion rates were in the range of those found in public health settings. These findings suggest that the commercial sector may be a valuable adjunct to more traditional venues for tuberculosis prevention. In addition, these newly developed claims-based methods offer a means to gain important insights and open new avenues to monitor, evaluate, and coordinate tuberculosis prevention.

Consumer attitudes and understanding of cholesterol-lowering claims on food: randomize mock-package experiments with plant sterol and oat fibre claims.

Science.gov (United States)

Wong, C L; Mendoza, J; Henson, S J; Qi, Y; Lou, W; L'Abbé, M R

2014-08-01

Few studies have examined consumer acceptability or comprehension of cholesterol-lowering claims on food labels. Our objective was to assess consumer attitudes and understanding of cholesterol-lowering claims regarding plant sterols (PS) and oat fibre (OF). We conducted two studies on: (1) PS claims and (2) OF claims. Both studies involved a randomized mock-packaged experiment within an online survey administered to Canadian consumers. In the PS study (n=721), we tested three PS-related claims (disease risk reduction claim, function claim and nutrient content claim) and a 'tastes great' claim (control) on identical margarine containers. Similarly, in the OF study (n=710), we tested three claims related to OF and a 'taste great' claim on identical cereal boxes. In both studies, participants answered the same set of questions on attitudes and understanding of claims after seeing each mock package. All claims that mentioned either PS or OF resulted in more positive attitudes than the taste control claim (Pprofile. How consumers responded to the nutrition claims between the two studies was influenced by contextual factors such as familiarity with the functional food/component and the food product that carried the claim. Permitted nutrition claims are approved based on physiological evidence and are allowed on any food product as long as it meets the associated nutrient criteria. However, it is difficult to generalize attitudes and understanding of claims when they are so highly dependent on contextual factors.

21 CFR 1306.13 - Partial filling of prescriptions.

Science.gov (United States)

2010-04-01

... 21 Food and Drugs 9 2010-04-01 2010-04-01 false Partial filling of prescriptions. 1306.13 Section 1306.13 Food and Drugs DRUG ENFORCEMENT ADMINISTRATION, DEPARTMENT OF JUSTICE PRESCRIPTIONS Controlled... by revising paragraph (a), effective June 1, 2010. For the convenience of the user, the revised text...

77 FR 48111 - Branded Prescription Drug Fee; Correction

Science.gov (United States)

2012-08-13

... DEPARTMENT OF THE TREASURY Internal Revenue Service 26 CFR Part 51 [REG-112805-10] RIN 1545-BJ39 Branded Prescription Drug Fee; Correction AGENCY: Internal Revenue Service (IRS), Treasury. ACTION: Notice..., August 6, 2012 (77 FR 46653) relating to the branded prescription drug fee imposed by the Affordable Care...

Getting a prescription filled

Science.gov (United States)

... get a prescription from your provider, you may buy the medicine in different ways. LOCAL PHARMACIES The most common ... long-term medicines you use for chronic problems. Buy short-term medicines and drugs that need to be stored at ...

Determinants of consumer understanding of health claims

DEFF Research Database (Denmark)

Grunert, Klaus G; Scholderer, Joachim; Rogeaux, Michel

2011-01-01

as safe, risky or other. In addition to the open questions on claim understanding, respondents rated a number of statements on claim interpretation for agreement and completed scales on interest in healthy eating, attitude to functional foods, and subjective knowledge on food and health. Results showed......The new EU regulation on nutrition and health claims states that claims can be permitted only if they can be expected to be understood by consumers. Investigating determinants of consumer understanding of health claims has therefore become an important topic. Understanding of a health claim...... on a yoghurt product was investigated with a sample of 720 category users in Germany. Health claim understanding was measured using open answers, which were subsequently content analysed and classified by comparison with the scientific dossier of the health claim. Based on this respondents were classified...

The influence of prescription monitoring programs on chronic pain management.

Science.gov (United States)

Wang, Jing; Christo, Paul J

2009-01-01

Abuse of prescribed controlled substance has become a serious social as well as health care issue over the past decade. A particularly alarming trend exists among patients aged 12 to 17. Common abuse behaviors include doctor shopping, drug theft, feigned pain symptoms to gain health care access, drug sharing, prescription forgery, and improper prescription practices. In response to this epidemic of abuse, many states have adopted prescription monitoring programs (PMPs). Such programs first originated in the early twentieth century. As of 2006, 38 states had such programs, many of which are supported by federal grants. As PMPs become more widespread, they have also increased in sophistication. By keeping a record of the prescription and dispensing of narcotics, these programs are able to build a comprehensive data network for tracking prescription medications. These databases aid law enforcement agencies in investigations of narcotic trafficking; they also help state regulatory boards to monitor improper prescription practices. This manuscript examines the basic structure of a PMP, including the way the data are collected and the way these data are stored and used. It also looks at the organizational differences amongst state programs. NASPER and Harold Rogers are two federal programs that provide funding to the state PMPs, and the current study examines the differences as well as similarities between these 2 programs. This study also compares the results of 2 reports: the U.S. General Accounting Office Study and the Twillman study.& Both studies have evaluated the efficiency of the PMPs. The U.S. General Accounting Office Study showed that while considerable differences exist among the state PMPs, these programs not only reduce the time and effort for law enforcement agencies to conduct investigations, but also cut the supply of prescription medications. However, the Twillman report suggests that prescription programs caused a shift in prescription practice, while

32 CFR 537.15 - Statutory authority for maritime claims and claims involving civil works of a maritime nature.

Science.gov (United States)

2010-07-01

... 32 National Defense 3 2010-07-01 2010-07-01 true Statutory authority for maritime claims and claims involving civil works of a maritime nature. 537.15 Section 537.15 National Defense Department of....15 Statutory authority for maritime claims and claims involving civil works of a maritime nature. (a...

Impact of the Hydrocodone Schedule Change on Opioid Prescription Patterns in South Dakota.

Science.gov (United States)

Kuschel, Lauren M; Mort, Jane M

2017-10-01

Prescription opioid use is becoming increasingly common; consequently, opioid overdose deaths are increasing at an alarming rate. Hydrocodone, one of the most commonly abused opioids, was changed from a schedule III controlled substance to the more stringent schedule II to decrease abuse and diversion, effective Oct. 6, 2014. The objective of this study was to examine the impact of the hydrocodone schedule change on opioid prescribing in South Dakota. Opioid prescription patterns were examined in the following six-month phases: the baseline phase before the change, the transition phase when existing hydrocodone prescriptions could still be refilled, and the final phase. The South Dakota Board of Pharmacy Prescription Drug Monitoring Program provided aggregate monthly data for South Dakota opioid prescriptions (i.e., total number of prescriptions and days supplied), including urban and rural stratification. T-tests were performed on the monthly values for each phase to determine the significance of differences in prescription features between phases. The number of hydrocodone prescriptions significantly decreased 14 percent from baseline to final phase, while the days supplied per prescription significantly increased 7.4 percent. These changes were greater in rural areas than in urban areas. Conversely, the number of other opioid prescriptions significantly increased by 6.5 percent over this timeframe. The number of hydrocodone prescriptions decreased, while the days supplied per prescription increased. These changes were greater in rural areas than in urban areas. In addition, the number of other opioid prescriptions increased. These trends may reflect some unintended effects of the schedule change.

Expanded pharmacy technician roles: Accepting verbal prescriptions and communicating prescription transfers.

Science.gov (United States)

Frost, Timothy P; Adams, Alex J

2017-11-01

As the role of the clinical pharmacist continues to develop and advance, it is critical to ensure pharmacists can operate in a practice environment and workflow that supports the full deployment of their clinical skills. When pharmacy technician roles are optimized, patient safety can be enhanced and pharmacists may dedicate more time to advanced clinical services. Currently, 17 states allow technicians to accept verbal prescriptions called in by a prescriber or prescriber's agent, or transfer a prescription order from one pharmacy to another. States that allow these activities generally put few legal limitations on them, and instead defer to the professional judgment of the supervising pharmacist whether to delegate these tasks or not. These activities were more likely to be seen in states that require technicians to be registered and certified, and in states that have accountability mechanisms (e.g., discipline authority) in place for technicians. There is little evidence to suggest these tasks cannot be performed safely and accurately by appropriately trained technicians, and the track record of success with these tasks spans four decades in some states. Pharmacists can adopt strong practice policies and procedures to mitigate the risk of harm from verbal orders, such as instituting read-back/spell-back techniques, or requiring the indication for each phoned-in medication, among other strategies. Pharmacists may also exercise discretion in deciding to whom to delegate these tasks. As the legal environment becomes more permissive, we foresee investment in more robust education and training of technicians to cover these activities. Thus, with the adoption of robust practice policies and procedures, delegation of verbal orders and prescription transfers can be safe and effective, remove undue stress on pharmacists, and potentially free up pharmacist time for higher-order clinical care. Copyright © 2016 Elsevier Inc. All rights reserved.

Differences in prevalence of prescription opiate misuse among rural and urban probationers.

Science.gov (United States)

Havens, Jennifer R; Oser, Carrie B; Leukefeld, Carl G; Webster, J Matthew; Martin, Steven S; O'Connell, Daniel J; Surratt, Hilary L; Inciardi, James A

2007-01-01

We compared the prevalence of prescription opiate misuse among 2 cohorts of felony probationers (N = 1525). Multiple logistic regression was utilized to determine the independent correlates of prescription opiate misuse among rural (n = 782) and urban (n = 743) probationers participating in an HIV-intervention study. After adjustment for differences in demographic and drug use characteristics, rural participants were almost five times more likely than their urban counterparts to have misused prescription opiates. The prevalence of prescription opiate misuse was significantly higher among the rural probationers; however, given the paucity of illicit opiates and relatively recent emergence of prescription opiates in rural areas, rural substance abuse treatment may be ill-prepared to treat prescription opiate misuse.

Impact of legislation and a prescription monitoring program on the prevalence of potentially inappropriate prescriptions for monitored drugs in Ontario: a time series analysis

Science.gov (United States)

Juurlink, David; Yao, Zhan; Camacho, Ximena; Paterson, J. Michael; Singh, Samantha; Dhalla, Irfan; Sproule, Beth; Mamdani, Muhammad

2014-01-01

Background The increased use of opioid analgesics, sedative hypnotics and stimulants, coupled with the associated risks of overdose have raised concerns around the inappropriate prescribing of these monitored drugs. We assessed the impact of new legislation, the Narcotics Safety and Awareness Act, and a centralized Narcotics Monitoring System (implemented November 2011 and May 2012, respectively), on the dispensing of prescriptions suggestive of misuse. Methods We conducted a time series analysis of publicly funded prescriptions for opioids, benzodiazepines and stimulants dispensed monthly in Ontario from January 2007 to May 2013, based on information in the Ontario Public Drug Benefit Database. In the primary analysis, a prescription was deemed potentially inappropriate if it was dispensed within 7 days of an earlier prescription and was for at least 30 tablets of a drug in the same class as the earlier prescription, but originated from a different physician and a different pharmacy. Results After enactment of the new legislation, the prevalence of potentially inappropriate opioid prescriptions decreased by 12.5% in 6 months (from 1.6% in October 2011 to 1.4% in April 2012; p = 0.01). No further significant change was observed after the introduction of the narcotic monitoring system (p = 0.8). By May 2013, the prevalence had dropped to 1.0%. Inappropriate benzodiazepine prescribing was significantly influenced by both the legislation (p significantly influenced by the introduction of the monitoring system in May 2012, falling from 0.7% in April 2012 to 0.3% in May 2013 (p = 0.02). Interpretation For a select group of drugs prone to misuse and diversion, legislation and a prescription monitoring program reduced the prevalence of prescriptions suggestive of misuse. This suggests that regulatory interventions can promote appropriate prescribing which could potentially be applied to other jurisdictions and drugs of concern. PMID:25485251

Nonmedical Prescription Drug Use among Midwestern Rural Adolescents

Science.gov (United States)

Park, Nicholas K.; Melander, Lisa; Sanchez, Shanell

2016-01-01

Prescription drug misuse has been an increasing problem in the United States, yet few studies have examined the protective factors that reduce risk of prescription drug abuse among rural adolescents. Using social control theory as a theoretical framework, we test whether parent, school, and community attachment reduce the likelihood of lifetime…

76 FR 59897 - Branded Prescription Drug Fee; Correction

Science.gov (United States)

2011-09-28

... DEPARTMENT OF THE TREASURY Internal Revenue Service 26 CFR Part 51 [TD 9544] RIN 1545-BK34 Branded... branded prescription drugs. This fee was enacted by section 9008 of the Patient Protection and Affordable...: This correction is effective on September 28, 2011 and applies to any fee on branded prescription drug...

Empiric antibiotic prescription among febrile under-five Children in ...

African Journals Online (AJOL)

limiting viral infection and therefore, would not require antibiotics. Over prescription of antibiotics increases antibiotics exposure and development of resistance among patients. There is need to evaluate empiric antibiotic prescription in order to limit ...

32 CFR 536.19 - Disaster claims planning.

Science.gov (United States)

2010-07-01

... 32 National Defense 3 2010-07-01 2010-07-01 true Disaster claims planning. 536.19 Section 536.19... AGAINST THE UNITED STATES The Army Claims System § 536.19 Disaster claims planning. All ACOs will prepare... requirements related to disaster claims planning. ...

Two Years of ePrescription in Slovenia - Applications and Potentials.

Science.gov (United States)

Stanimirovic, Dalibor; Savic, Dusan

2018-01-01

ePrescription is one of the most successful eHealth solutions in Slovenia. Since its national roll-out in early 2016, the quality of its operations has been constantly improving, and the number of users has been growing ever since to reach today's 90% of all healthcare providers. ePrescription facilitates more transparent and safer prescribing of medications, an overview of possible medication interactions, and reduction of administrative and opportunity costs. This paper initially explores the current state of ePrescription in Slovenia and different aspects of its application. Based on the research findings, the paper finally outlines potentials of ePrescription, which could be transformed into tangible benefits with particular implications for healthcare system. The research is based on focus group methodology. Structured discussions were conducted with eminent experts currently in charge of ePrescription (and other eHealth solutions) development and implementation in Slovenia. Research results imply that certain application aspects are relatively easy to define and evaluate, while the overall potentials of ePrescription are difficult to determine in many cases, and relatively unexplored in terms of their implications and operational feasibility.

Operating room fires: a closed claims analysis.

Science.gov (United States)

Mehta, Sonya P; Bhananker, Sanjay M; Posner, Karen L; Domino, Karen B

2013-05-01

To assess patterns of injury and liability associated with operating room (OR) fires, closed malpractice claims in the American Society of Anesthesiologists Closed Claims Database since 1985 were reviewed. All claims related to fires in the OR were compared with nonfire-related surgical anesthesia claims. An analysis of fire-related claims was performed to identify causative factors. There were 103 OR fire claims (1.9% of 5,297 surgical claims). Electrocautery was the ignition source in 90% of fire claims. OR fire claims more frequently involved older outpatients compared with other surgical anesthesia claims (P fire claims (P fires (n = 93) increased over time (P fires occurred during head, neck, or upper chest procedures (high-fire-risk procedures). Oxygen served as the oxidizer in 95% of electrocautery-induced OR fires (84% with open delivery system). Most electrocautery-induced fires (n = 75, 81%) occurred during monitored anesthesia care. Oxygen was administered via an open delivery system in all high-risk procedures during monitored anesthesia care. In contrast, alcohol-containing prep solutions and volatile compounds were present in only 15% of OR fires during monitored anesthesia care. Electrocautery-induced fires during monitored anesthesia care were the most common cause of OR fires claims. Recognition of the fire triad (oxidizer, fuel, and ignition source), particularly the critical role of supplemental oxygen by an open delivery system during use of the electrocautery, is crucial to prevent OR fires. Continuing education and communication among OR personnel along with fire prevention protocols in high-fire-risk procedures may reduce the occurrence of OR fires.

Risk factors for medication errors in the electronic and manual prescription.

Science.gov (United States)

Volpe, Cris Renata Grou; Melo, Eveline Maria Magalhães de; Aguiar, Lucas Barbosa de; Pinho, Diana Lúcia Moura; Stival, Marina Morato

2016-08-08

to compare electronic and manual prescriptions of a public hospital of Brasilia, identifying risk factors for the occurrence of medication errors. descriptive-exploratory, comparative and retrospective study. Data collection occurred from July 2012 to January 2013, using an instrument for the review of the information contained in medical records related to the medication process. A total of 190 manual and 199 electronic records composed the sample, with 2027 prescriptions each. compared to the manual prescription, a significant reduction was observed in the risk factors after implantation of the electronic prescription, in items such as "lack of the form of dilution" (71.1% to 22.3%) and "prescription with brand name" (99.5% to 31.5%). Conversely, the risk factors "no check" and "lack of CRM of the prescriber" increased. The lack of the allergy registration and the occurrences related to medication were the same for both groups. generally, the use of the electronic prescription system was associated with a significant reduction in risk factors for medication errors, concerning the following aspects: illegibility, prescription with brand name and presence of essential items that provide a safe and effective prescription. comparar as prescrições eletrônicas e manuais de um hospital público do Distrito Federal, identificando os fatores de risco para ocorrência de erros de medicação. Estudo descritivo-exploratório, comparativo e retrospectivo. A coleta de dados ocorreu no período de julho de 2012 a janeiro de 2013, através de instrumento para revisão das informações referentes ao processo de medicação contidas em prontuários. Integraram a amostra 190 prontuários manuais e 199 eletrônicos, com 2027 prescrições cada. na comparação com a prescrição manual, observou-se redução significativa dos fatores de risco após implantação da eletrônica, em itens como "falta da forma de diluição" (71,1% e 22,3%) e "prescrição com nome comercial" (99

38 CFR 3.160 - Status of claims.

Science.gov (United States)

2010-07-01

..., Compensation, and Dependency and Indemnity Compensation Claims § 3.160 Status of claims. The following definitions are applicable to claims for pension, compensation, and dependency and indemnity compensation. (a... for a benefit received after final disallowance of an earlier claim, or any application based on...

An inevitable wave of prescription drug monitoring programs in the context of prescription opioids: pros, cons and tensions.

Science.gov (United States)

Islam, M Mofizul; McRae, Ian S

2014-08-16

In an effort to control non-medical use and/or medical abuse of prescription drugs, particularly prescription opioids, electronic prescription drug monitoring programs (PDMP) have been introduced in North-American countries, Australia and some parts of Europe. Paradoxically, there are simultaneous pressures to increase opioid prescribing for the benefit of individual patients and to reduce it for the sake of public health, and this pressure warrants a delicate balance of appropriate therapeutic uses of these drugs with the risk of developing dependence. This article discusses pros and cons of PDMP in reducing diversion of prescription opioids, without hampering access to those medications for those with genuine needs, and highlights tensions around PDMP implementation. PDMPs may help alleviate diversion, over-prescription and fraudulent prescribing/dispensing; prompt drug treatment referrals; avoid awkward drug urine test; and inform spatial changes in prescribing practices and help designing tailored interventions. Fear of legal retribution, privacy and data security, potential confusion about addiction and pseudo-addiction, and potential undue pressure of detecting misuse/diversion - are the major problems. There are tensions about unintended consequence of excessive regulatory enforcements, corresponding collateral damages particularly about inadequate prescribing for patients with genuine needs, and mandatory consultation requirements of PDMP. In this era of information technology PDMP is likely to flourish and remain with us for a long time. A clear standard of practice against which physicians' care will be judged may expedite the utilisation of PDMP. In addition, adequate training on addiction and pain management along with public awareness, point-of-supply data entry from pharmacy, point-of-care real-time access to data, increasing access to addiction treatment and appropriate regulatory enforcement preferably through healthcare administration, together

Health Claims Data Warehouse (HCDW)

Data.gov (United States)

Office of Personnel Management — The Health Claims Data Warehouse (HCDW) will receive and analyze health claims data to support management and administrative purposes. The Federal Employee Health...

Identification of Patients with Statin Intolerance in a Managed Care Plan: A Comparison of 2 Claims-Based Algorithms.

Science.gov (United States)

Bellows, Brandon K; Sainski-Nguyen, Amy M; Olsen, Cody J; Boklage, Susan H; Charland, Scott; Mitchell, Matthew P; Brixner, Diana I

2017-09-01

While statins are safe and efficacious, some patients may experience statin intolerance or treatment-limiting adverse events. Identifying patients with statin intolerance may allow optimal management of cardiovascular event risk through other strategies. Recently, an administrative claims data (ACD) algorithm was developed to identify patients with statin intolerance and validated against electronic medical records. However, how this algorithm compared with perceptions of statin intolerance by integrated delivery networks remains largely unknown. To determine the concurrent validity of an algorithm developed by a regional integrated delivery network multidisciplinary panel (MP) and a published ACD algorithm in identifying patients with statin intolerance. The MP consisted of 3 physicians and 2 pharmacists with expertise in cardiology, internal medicine, and formulary management. The MP algorithm used pharmacy and medical claims to identify patients with statin intolerance, classifying them as having statin intolerance if they met any of the following criteria: (a) medical claim for rhabdomyolysis, (b) medical claim for muscle weakness, (c) an outpatient medical claim for creatinine kinase assay, (d) fills for ≥ 2 different statins excluding dose increases, (e) decrease in statin dose, or (f) discontinuation of a statin with a subsequent fill for a nonstatin lipid-lowering therapy. The validated ACD algorithm identified statin intolerance as absolute intolerance with rhabdomyolysis; absolute intolerance without rhabdomyolysis (i.e., other adverse events); or as dose titration intolerance. Adult patients (aged ≥ 18 years) from the integrated delivery network with at least 1 prescription fill for a statin between January 1, 2011, and December 31, 2012 (first fill defined the index date) were identified. Patients with ≥ 1 year pre- and ≥ 2 years post-index continuous enrollment and no statin prescription fills in the pre-index period were included. The MP and

The Prescription Drug Marketing Act of 1987.

Science.gov (United States)

Greenberg, R B

1988-10-01

The Prescription Drug Marketing Act of 1987 is described, and its implications for hospitals and other health-care entities are discussed. The act, which became effective on July 21, 1988, is intended to reduce public health risks from adulterated, misbranded, and counterfeit drug products that enter the marketplace through drug diversion. The law provides that prescription drug products manufactured in the United States and exported can no longer be reimported, except by the product's manufacturer. It also establishes restrictions on sales of prescription drug products and samples. Samples of prescription drug products may be distributed only if a licensed prescriber requests them. Other distribution channels for samples specified in the law are permissible, provided records are maintained. Under the law, wholesale distributors must be licensed by the state and meet uniform standards. Penalties for violations of the law are also identified. According to FDA's advisory guidelines on the statute, the law will permit hospitals to return drug products, provided the return is made to the manufacturer or wholesaler and provided written notice is secured that the goods were received (for manufacturers) or the goods were destroyed or returned to the manufacturer (for wholesalers). The final chapter on drug diversion must await issuance of final FDA regulations.

[Prescription drug abuse in elderly psychiatric patients].

Science.gov (United States)

Wetterling, Tilman; Schneider, Barbara

2012-08-01

Due to demographic changes there will be a fraction of elderly patients with substance use disorders. However, only a few data have been published about elderly abusers of prescription drugs. Since substance abuse is frequently comorbid with psychiatric disorders, treatment in a psychiatric hospital is often needed. In this explorative study elderly people with prescription drug abuse who required psychiatric inpatient treatment should be characterized. This study was part of the gerontopsychiatry study Berlin (Gepsy-B), an investigation of the data of all older inpatients (≥ 65 years) admitted to a psychiatric hospital within a period of 3 years. Among 1266 documented admissions in 110 cases (8.7 %) (mean age: 75.7 ± 7.1 years) prescription drug abuse, mostly of benzodiazepines was diagnosed. Females showed benzodiazepine abuse more often than males. In only a small proportion of the cases the reason for admission was withdrawal of prescribed drugs. 85.5 % suffered from psychiatric comorbidity, mostly depression. As risk factors for abuse depressive symptoms (OR: 3.32) as well as concurrent nicotine (OR: 2.69) or alcohol abuse (OR: 2.14) were calculated. Psychiatric inpatient treatment was primarily not necessary because of prescription drug abuse but because of other psychopathological symptoms. © Georg Thieme Verlag KG Stuttgart · New York.

37 CFR 360.5 - Copies of claims.

Science.gov (United States)

2010-07-01

... Section 360.5 Patents, Trademarks, and Copyrights COPYRIGHT ROYALTY BOARD, LIBRARY OF CONGRESS SUBMISSION OF ROYALTY CLAIMS FILING OF CLAIMS TO ROYALTY FEES COLLECTED UNDER COMPULSORY LICENSE Cable Claims... hand delivery or by mail, file an original and one copy of the claim to cable royalty fees. ...

Psychotropic medicine prescriptions in Italian youths: a multiregional study.

Science.gov (United States)

Piovani, Daniele; Clavenna, Antonio; Cartabia, Massimo; Bonati, Maurizio

2016-03-01

The aim of the study was to evaluate the trend of paediatric psychotropic drug prescriptions in Italy. Data sources were regional, outpatient prescription databases. Seven Italian regions, covering 50 % of the Italian population, provided data from 2006 to 2011. Prevalence and incidence of prescriptions by age and gender were evaluated for psychotropic, antidepressant, antipsychotic, and attention-deficit/hyperactivity disorders (ADHD) medications. The hospital admission rate for psychiatric conditions was calculated, also at the local health unit (LHU) level. The presence of trends in prescription prevalence and incidence during the 6 year period was assessed. Finally, the correlation between prevalence, prescription, hospital admission rates, latitude, longitude, and average annual income at the LHU level was also investigated. In 2011, 8834 youths received at least one psychotropic drug prescription, with a prevalence of 1.76 ‰ (95 % CI 1.72-1.80). The incidence of new psychotropic drug users was 1.03 ‰ (1.00-1.06). The prevalence of antidepressants was 1.02 ‰ (0.99-1.04), while that of antipsychotics was 0.70 ‰ (0.68-0.72), and that of ADHD medications 0.19 ‰ (0.18-0.21). The psychotropic drug prevalence increased with increasing age. Males were more exposed to psychotropic drugs than females (AUC0-17 male/female = 1.23). Antipsychotics were the most prescribed psychotropic drugs in males, while antidepressants were in females. Between-region prevalence ranged from 1.56 to 2.17 ‰. The overall prevalence of psychotropic drug from 2006 to 2011 was stable (χ(t)2 ≤ 0.001, p = 0.97). No correlation was found between prevalence and the variables investigated. Psychotropic drug prescription was very limited and stable. No geographical patterns were found.

Association of childhood abuse and prescription opioid use in early adulthood.

Science.gov (United States)

Austin, Anna E; Shanahan, Meghan E; Zvara, Bharathi J

2018-01-01

Previous research has examined the association of childhood abuse with opioid misuse and dependence in adulthood. However, little research has focused specifically on prescription opioids, and no studies have examined associations with prescription opioid use, a potential pathway to later opioid misuse and dependence. The aim of the present study was to examine the association of childhood emotional, physical, and sexual abuse with prescription opioid use in early adulthood. We used data from Waves I (12-18years) and IV (24-32years) of the National Longitudinal Study of Adolescent to Adult Health. At Wave IV, respondents reported experiences of childhood abuse occurring prior to age 18years and prescription opioid use in the last four weeks. We conducted multivariable logistic regression to examine associations of childhood abuse with recent prescription opioid use. In multivariable models adjusted for respondent sex, race/ethnicity, age, and socioeconomic status, childhood emotional abuse (OR=1.57, 95% CI 1.29, 1.90), physical abuse (OR=1.46, 95% CI 1.14, 1.87), and any childhood abuse (OR=1.51, 95% CI 1.24, 1.82) were significantly associated with recent prescription opioid use. Given continued increases in prescription opioid use and opioid-related morbidity and mortality in the U.S., understanding upstream social and environmental factors associated with prescription opioid use is important to strengthening and expanding current prevention and intervention strategies. Future research is needed to examine factors potentially mediating the association between childhood abuse and prescription opioid use in order to provide additional insights for prevention and intervention efforts. Copyright © 2017 Elsevier Ltd. All rights reserved.

Moral hazard and prescription medicine use in Australia--the patient perspective.

Science.gov (United States)

Doran, Evan; Robertson, Jane; Henry, David

2005-04-01

All Australian citizens are provided affordable access to prescription medicines through the nation's system of universal pharmaceutical subsidies--the pharmaceutical benefits scheme. The rapid increase in pharmaceutical related expenditure has generated the concern that Australians are taking advantage of prescription subsidies and are using more medicines than are necessary, thereby creating a 'moral hazard'. This concern is predicated on a number of assumptions about patient behaviour rather than on empirical observation. These assumptions amount to a view that patients are consumers who treat prescription medicines as common goods subject to informed and rational calculation of the cost and benefits of their use. This paper reports the findings of an in-depth interview study undertaken to explore how prescription cost influences Australians' medicine use. Qualitative data were analysed to compare medicine users' descriptions of the role of prescription cost in medicine use against the assumptions that underlie the belief in moral hazard. Moral hazard did not appear to be significantly operating in the accounts of medicine use collected for this study. Interviewees' accounts of medicine use revealed an act characterised by ambivalence, a mix of desire and antipathy, faith and suspicion. Medicines appeared in interviewees' accounts as both pharmacologically and symbolically potent substances, which despite their familiarity as objects, are often mysterious to non-expert patients. Cost appeared as a secondary factor in patients' decision to access a prescription medicine. Using a prescription was predicated on the medicine being necessary, with necessity typically established by an expert doctor prescribing the medicine. Prescription medicines did not appear as 'common goods' where subsidised access motivates a 'consumer' to demand more or make the prospect of prescription use more attractive or necessary.

The application characteristics of Zhongjing external prescription medicine

Directory of Open Access Journals (Sweden)

Hui Zhao

2017-12-01

Full Text Available Objective: To explore the application characteristics of Zhongjing prescription topical Chinese medicine. Methods: in this paper, according to the dosage form, Zhongjing topical agent will be divided into suppository, smoked lotion, apply is scattered, plug nasal powder four categories. Through an analysis on its books, records, and clinical applications, we are able to sum up the application characteristics of the zhongjing agent for external use. Results: in the clinical medicine, topical Zhongjing prescription cure of the disease has a long history of the role, through the analysis of Zhongjing topical prescription whole thinking, dialectical thinking, and thinking and characteristics of treatment technology that has the characteristics of topical drugs, dosage form differentiation flexible, external treatment for internal diseases, both inside and outside. Conclusion: topical medicine not only in the clinical treatment effect is good, and to inherit and develop Zhang Zhongjing thought of medicine, medical practice, law, strengthen Zhong Jing prescription and medicine, to enrich TCM clinical diagnosis and treatment methods to improve the clinical efficacy of traditional Chinese medicine, Chinese medicine clinics provide high standards of service for patients.

Geographical and temporal variations in clozapine prescription for schizophrenia

DEFF Research Database (Denmark)

Nielsen, Jimmi; Røge, Rasmus; Schjerning, Ole

2012-01-01

Despite its unsurpassed efficacy in treatment-resistant schizophrenia, clozapine remains underutilized. Trends in the prescription of clozapine in patients with ICD-10 F20.x schizophrenia were assessed using data from Danish national registers. Three substudies were carried out: (i) an assessment...... of differences in national prescription patterns between 1996 and 2007 using a cross-sectional design; (ii) a comparison of time from first schizophrenia diagnosis to first prescription of clozapine in a five-year cohort study, using the Cox regression model, of two patient groups who were first diagnosed...

Antibiotic prescriptions for outpatient acute rhinosinusitis in Canada, 2007-2013

Science.gov (United States)

Weese, Scott; Glass-Kaastra, Shiona; McIsaac, Warren

2017-01-01

Introduction Acute rhinosinusitis (ARS) is a respiratory disease commonly caused by viral infections. Physicians regularly prescribe antibiotics despite bacterial etiologies being uncommon. This is of concern, as this use adds to the selection pressure for resistance. Here we present the descriptive epidemiology of acute rhinosinusitis and corresponding antibiotic prescribing practices by Canadian outpatient physicians from 2007–2013. Materials/Methods Diagnosis and antibiotic prescription data for ARS were extracted from the Canadian Disease and Therapeutic Index for 2007 to 2013, and population data were acquired from Statistics Canada. ARS diagnosis and antibiotic prescription rates and frequencies of antibiotic classes were calculated. Results Eighty-eight percent of patients diagnosed with ARS in 2013 were adults, with a greater rate of antibiotic prescriptions observed among the adults relative to the pediatric patients (1632.9 and 468.6 antibiotic prescriptions per 10,000 inhabitants). Between 2007 and 2013, the ARS diagnosis rate decreased from 596 to 464 diagnoses per 10,000 inhabitants, while the percentage of diagnoses with antibiotic prescriptions at the national level remained stable (87% to 84%). From 2007 to 2013, prescription rates for macrolides decreased from 203.5 to 105.4 prescriptions per 10,000 inhabitants. In 2013, penicillins with extended spectrum were more commonly prescribed compared to macrolides among adult patients (153.5 and 105.4 prescriptions per 10,000 inhabitants, respectively). Conclusion This study is the first to describe physician antibiotic prescribing practices for treatment of ARS in Canada. Results show that antibiotic treatment for ARS represents an area for implementing antimicrobial stewardship, and through it, managing antibiotic resistance. Further work is required to better understand diagnosing practices and treatment criteria for ARS, and use this information to further assist physicians to limit unnecessary

Claim prevention at reactor facilities

International Nuclear Information System (INIS)

Colby, B.P.

1987-01-01

Why does a radiation worker bring a claim alleging bodily injury from radiation exposure? Natural cancer, fear of radiation induced cancer, financial gain, emotional distress and mental anguish are some reasons for workers' claims. In this paper the author describes what power reactor health physicists are doing to reduce the likelihood of claims by establishing programs which provide sound protection of workers, prevent radiological events, improve workers' knowledge of radiological conditions and provide guidance for radiological incident response

40 CFR 35.6600 - Contractor claims.

Science.gov (United States)

2010-07-01

... 40 Protection of Environment 1 2010-07-01 2010-07-01 false Contractor claims. 35.6600 Section 35... Actions Procurement Requirements Under A Cooperative Agreement § 35.6600 Contractor claims. (a) General... prepared by the contractor to support a claim against the recipient; and (4) The award official determines...

Asthma prescription patterns for children: can GPs do better?

NARCIS (Netherlands)

Uijen, J.H.J.M.; Wouden, J.C. van der; Schellevis, F.G.; Willemsen, S.P.; Suijlekom-Smit, L.W.A. van; Bindels, P.J.E.

2011-01-01

Background: Assessing prescription patterns of asthma medication for children is helpful to optimize prescribing by general practitioners (GPs). The aim was to explore prescription patterns in children with physician-diagnosed asthma and its determinants in general practice. Methods: We used the

Use of a generic protocol in documentation of prescription errors in Estonia, Norway and Sweden

Directory of Open Access Journals (Sweden)

Haavik S

2012-06-01

Full Text Available Pharmacists have an important role in detecting, preventing, and solving prescription problems, which if left unresolved, may pose a risk of harming the patient.Objective: The objectives of this study were to evaluate the feasibility of a generic study instrument for documentation of prescription problems requiring contact with prescriber before dispensing. The study was organized: 1 by countries: Estonia, Norway and Sweden; 2 by type of prescriptions: handwritten prescriptions, printouts of prescriptions in the electronic medical record and electronically transmitted prescriptions to pharmacies; and 3 by recording method - self-completion by pharmacists and independent observers.Methods: Observational study with independent observers at community pharmacies in Estonia (n=4 and Sweden (n=7 and self-completed protocols in Norway (n=9.Results: Pharmacists’ in Estonia contacted the prescriber for 1.47% of the prescriptions, about 3 times as often as in Norway (0.45% and Sweden (0.38%. Handwritten prescriptions dominated among the problem prescriptions in Estonia (73.2%, printouts of prescriptions in the electronic medical record (89.1% in Norway and electronically transmitted prescriptions to pharmacies (55.9% in Sweden.More administrative errors were identified on handwritten prescriptions and printouts of prescriptions in the electronic medical record in Estonia and in Norway compared with electronically transmitted prescriptions to pharmacies in Sweden (p<0.05 for prescription types and p<0.01 for countries. However, clinically important errors and delivery problems appeared equally often on the different types of prescriptions. In all three countries, only few cases of drug interactions and adverse drug reactions were identified.Conclusion: Despite the different patterns of prescription problems in three countries, the instrument was feasible and can be regarded appropriate to document and classify prescription problems necessitating contact

PRESCRIPTION OF PHYSICAL EXERCISES FOR ELDERLY

Directory of Open Access Journals (Sweden)

Sheilla Tribess

2005-11-01

Full Text Available The present study has as objective investigates the prescription of exercises for elderly, constant in the literature in portuguese language, under form of books, newspapers, annals and publications electronics. For so much, it tried to collect data with relationship to the following aspects: a Impact of the aging in the human organism; b evaluation of the components of the functional aptitude; and, c composition of a program of physical exercise. The aging process evidences changes in the levels antropométrics, neuromuscular, cardiovascular, lung, neural, besides the decrease of the agility, coordination, balance, flexibility, mobility to articulate and increase in the cartilage rigidity, tendons and ligaments. Those changes associated to the low level of physical activity in the elderly take to the decline of the functional capacity. The evaluation of the level of functional dependence becomes important to the elderly, because it will provide a prescription of physical exercises more addressed your needs, increasing the effectiveness of the program and reducing the risks. The general beginnings for the prescription of physical exercises for elderly are based in the modalities appropriate, intensity, duration, frequency and progression of the physical activity, with the objective of improving the life quality, to minimize the physiologic alterations, to improve the motive capacity and to provide benefits social, psychological and physical. Therefore, in the prescription of physical exercises for older people is necessary the training of the capacity aerobics, of the force, of the balance, of the time of reaction and movement and of the agility.

Bleeding risk of apixaban, dabigatran, and low-dose rivaroxaban compared with warfarin in Japanese patients with non-valvular atrial fibrillation: a propensity matched analysis of administrative claims data.

Science.gov (United States)

Kohsaka, Shun; Murata, Tatsunori; Izumi, Naoko; Katada, Jun; Wang, Feng; Terayama, Yasuo

2017-11-01

There is scarce evidence comparing novel oral anticoagulants (NOACs) with warfarin in real-world settings in Japan. This study compared the risk of bleeding events among patients with non-valvular atrial fibrillation (NVAF) initiating treatment with NOACs versus warfarin. A retrospective cohort study was conducted using a de-identified electronic health record based database of health claims and Diagnosis Procedure Combination data from 275 consenting hospitals in Japan. NVAF patients newly initiated on oral anticoagulants were eligible. Based on the first prescription, patients were assigned to 5/2.5 mg BID apixaban, 150/110 mg BID dabigatran, 15/10 mg QD rivaroxaban (approved dose lower in Japan compared to Western countries [20/15 mg QD]) or warfarin groups. One-to-one propensity score matching (PSM) was used to balance patient characteristics between warfarin and each NOAC. Patients were followed up to 1 year post-first prescription. Among 38,662 eligible patients, a total of 5977, 5090, and 6726 matched pairs were identified for warfarin versus apixaban, warfarin versus dabigatran, and warfarin versus rivaroxaban, respectively after PSM. Compared to warfarin, apixaban (hazard ratio [HR] 0.586; 95% CI 0.421-0.815), dabigatran (HR 0.617; 0.425-0.895) and rivaroxaban (HR 0.693; 0.514-0.933) were associated with a significantly lower risk of major bleeding. The risk of any bleeding was significantly lower for apixaban (HR 0.782; 0.682-0.896), but not for dabigatran (HR 0.988; 0.860-1.135) or rivaroxaban (HR 0.938; 0.832-1.057) when comparing to warfarin. Among Japanese patients with NVAF, treatment with apixaban 5/2.5 mg BID was associated with a significantly lower risk of major bleeding and any bleeding when compared to warfarin. Treatment with dabigatran 150/110 mg BID or rivaroxaban 15/10 mg QD was associated with a significantly lower risk of major bleeding, but not any bleeding, than warfarin. The potential benefit of individual NOACs in real

31 CFR 361.8 - Claim for replacement.

Science.gov (United States)

2010-07-01

... 31 Money and Finance: Treasury 2 2010-07-01 2010-07-01 false Claim for replacement. 361.8 Section... § 361.8 Claim for replacement. Claim for replacement shall be made in writing to the Secretary, to the..., Parkersburg, WV 26106-1328. The claim, accompanied by a recommendation regarding the manner of replacement...

Reserving by detailed conditioning on individual claim

Science.gov (United States)

Kartikasari, Mujiati Dwi; Effendie, Adhitya Ronnie; Wilandari, Yuciana

2017-03-01

The estimation of claim reserves is an important activity in insurance companies to fulfill their liabilities. Recently, reserving method of individual claim have attracted a lot of interest in the actuarial science, which overcome some deficiency of aggregated claim method. This paper explores the Reserving by Detailed Conditioning (RDC) method using all of claim information for reserving with individual claim of liability insurance from an Indonesian general insurance company. Furthermore, we compare it to Chain Ladder and Bornhuetter-Ferguson method.

Tradeoffs of Using Administrative Claims and Medical Records to Identify the Use of Personalized Medicine for Patients with Breast Cancer

Science.gov (United States)

Liang, Su-Ying; Phillips, Kathryn A.; Wang, Grace; Keohane, Carol; Armstrong, Joanne; Morris, William M.; Haas, Jennifer S.

2012-01-01

Background Administrative claims and medical records are important data sources to examine healthcare utilization and outcomes. Little is known about identifying personalized medicine technologies in these sources. Objectives To describe agreement, sensitivity, and specificity of administrative claims compared to medical records for two pairs of targeted tests and treatments for breast cancer. Research Design Retrospective analysis of medical records linked to administrative claims from a large health plan. We examined whether agreement varied by factors that facilitate tracking in claims (coding and cost) and that enhance medical record completeness (records from multiple providers). Subjects Women (35 – 65 years) with incident breast cancer diagnosed in 2006–2007 (n=775). Measures Use of human epidermal growth factor receptor 2 (HER2) and gene expression profiling (GEP) testing, trastuzumab and adjuvant chemotherapy in claims and medical records. Results Agreement between claims and records was substantial for GEP, trastuzumab, and chemotherapy, and lowest for HER2 tests. GEP, an expensive test with unique billing codes, had higher agreement (91.6% vs. 75.2%), sensitivity (94.9% vs. 76.7%), and specificity (90.1% vs. 29.2%) than HER2, a test without unique billing codes. Trastuzumab, a treatment with unique billing codes, had slightly higher agreement (95.1% vs. 90%) and sensitivity (98.1% vs. 87.9%) than adjuvant chemotherapy. Conclusions Higher agreement and specificity were associated with services that had unique billing codes and high cost. Administrative claims may be sufficient for examining services with unique billing codes. Medical records provide better data for identifying tests lacking specific codes and for research requiring detailed clinical information. PMID:21422962

32 CFR 842.43 - Filing a claim.

Science.gov (United States)

2010-07-01

... completed Standard Form 95 or other signed and written demand for money damages in a sum certain. A claim... Defense Department of Defense (Continued) DEPARTMENT OF THE AIR FORCE CLAIMS AND LITIGATION ADMINISTRATIVE... amend a claim at any time prior to final action. To amend a claim, the claimant or his or her authorized...

Benzodiazepine prescription in relation to psychiatric diagnosis and patient characteristics: A pilot study

Directory of Open Access Journals (Sweden)

Marić Nađa P.

2015-01-01

Full Text Available Introduction: Benzodiazepines are widely used drugs which are often misused. Analysis of psychotropic drugs prescription in Serbia showed high prescription rate of benzodiazepines in the psychiatric patient population, with an increasing trend. Potential association between psychiatric diagnostic categories (organic brain syndrome, psychotic disorders, bipolar disorder, unipolar depression, anxiety disorder, personality disorder, or the sociodemographic characteristics of patients (gender, age, education, marital state and benzodiazepine prescribing practice was not thoroughly tested. Aim: By analyzing routine practice of the university clinic, the aim of this study was to examine whether there is an association between clinical or socio-demographic characteristics of the patients and benzodiazepine prescribing practice. Material and methods: This study was carried out by retrospective analysis of the patient's medical charts after hospital discharge (n=102. Data analysis included descriptive statistics, testing the difference between groups and correlation analysis. Results: At the discharge, 94.1% of patients had benzodiazepines prescribed, with an average dose of 4.6 ± 3.2mg lorazepam dose equivalents. It is shown that female patients were prescribed with higher doses of benzodiazepines than male patients (p=0.018, that the average dose was higher for patients treated with an overall larger number of psychiatric drugs (p = 0.013, as well as that hospital inpatients had higher doses compared to day hospital-treated patients (p = 0.011. Patients with a diagnosis of personality disorder had a slight upward trend of benzodiazepine dose (p=0.078. Conclusion: Current research provided a clear insight into the actual practice of benzodiazepine prescription at local university center. Similarly to our region, indications for prescribing benzodiazepines appear to be quite broad and not specific enough worldwide. This is why it is important to

Survey of malpractice claims in dermatology

International Nuclear Information System (INIS)

Altman, J.

1975-01-01

A statistical survey of malpractice claims asserted against dermatologists was made. The subject matter of the claims was divided into eight major categories: drug reactions, x-ray burns, poor cosmetic result following surgery, poor cosmetic result following medication, failure to diagnose cancer, improper diagnosis, infection from treatment, and miscellaneous. The study showed that a group of ''serious'' damage cases, which accounted for 34 percent of total claims, generated 94 percent of total dollar losses. The problem areas for malpractice claims appeared to be drug reactions, cosmetic chemosurgery, and failure to diagnose cancer. (U.S.)

Teens, Drugs, & Vegas: Toxicological surveillance of illicit prescription and illegal drug abuse in adolescents (12-17 years) using post-mortem data in Clark County, Nevada from 2005 to 2015.

Science.gov (United States)

Paul, Anthea B Mahesan; Simms, Lary; Mahesan, Andrew A; Belanger, Eric Charles

2018-04-14

Illegal drug abuse, particularly prescription drug abuse is a growing problem in the United States. Research on adolescent drug abuse is based on national self-reported data. Using local coroner data, quantitative prevalence of illegal substance toxicology and trends can be assessed to aid directed outreach and community-based prevention initiatives. Retrospective analysis was conducted on all cases aged 12-17 years referred to the Office of the Medical Examiner, Clark County from 2005 to 2015 (n = 526). The prevalence of illegal opioid use in this population was 13.3%. The most commonly used drug was tetrahydrocannabinol (THC) in 29.7%. Illegal-prescription opioids and benzodiazepines were used approximately 1.7 times as much as all other illegal-drugs, excluding THC combined. The largest proportion of illicit prescription drug users were accidental death victims (p = 0.02, OR = 2.02). Drug trends by youth are ever evolving and current specific data is necessary to target prevention initiatives in local communities. Copyright © 2018 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

Cervical cancer: intracavitary dose specification and prescription

International Nuclear Information System (INIS)

Potish, R.A.; Gerbi, B.J.

1987-01-01

Dose and volume specifications for reporting intracavitary therapy were analyzed according to criteria recommended by the International Commission on Radiation Units and Measurements (ICRU). Ninety Fletcher-Suit radium applications were studied to examine the validity of the assumptions of the ICRU and the merit of their routine reporting. It was demonstrated that the reporting recommendations were inconsistent with clinical prescription systems and added little to dose specification. The distinction between dose specification and dose prescription was stressed

Differences in psychotropic drug prescriptions among ethnic groups in the Netherlands.

Science.gov (United States)

Wittkampf, Laura Christina; Smeets, Hugo M; Knol, Mirjam J; Geerlings, Mirjam I; Braam, Arjan W; De Wit, Niek J

2010-08-01

Psychotropic drug use in Europe and the USA has increased in the past 20 years. The rise in mental health-care use instigated a debate about possible differences in prevalence rates between different ethnic groups in the Netherlands, although the exact differences were unknown. The aim of this study was to determine whether these minority groups were more or less likely than the native population to receive psychotropic drugs. A descriptive population study was conducted using the Agis Health Database, containing demographic and health-care consumption data of approximately 1.5 million inhabitants of the Netherlands. Rates of prescriptions of psychotropic drugs from 2001 to 2006 and adjusted odds ratios for psychotropic drug prescriptions among native Dutch, Turkish and Moroccan ethnic groups were calculated. These data were analysed using logistic regression, after being adjusted for age, gender and socioeconomic status. The mean year prevalence of psychotropic drug prescriptions from 2001 to 2006 was 14.0%. Except for a decrease in anxiolytic drugs, the prescriptions of psychotropic drugs increased from 2001 to 2006. These trends were the same for all of the ethnic groups considered. Among both the Moroccan and Turkish populations, there was a higher risk of antidepressant and antipsychotic drug prescriptions, and a pronounced lower risk of ADHD medication and lithium prescriptions compared to the native population. Among the Turkish population, the risk of anxiolytic drug prescriptions was greater than in the native population. Compared to the native population in the Netherlands, first- and second-generation Turkish and Moroccan immigrants had an increased risk of antidepressant and antipsychotic drug prescriptions and a decreased risk of ADHD medication and Lithium prescriptions. Further research is needed to clarify whether patients of different ethnic backgrounds with the same symptoms receive similar diagnosis and adequate treatment.

37 CFR 7.12 - Claim of color.

Science.gov (United States)

2010-07-01

... 37 Patents, Trademarks, and Copyrights 1 2010-07-01 2010-07-01 false Claim of color. 7.12 Section... § 7.12 Claim of color. (a) If color is claimed as a feature of the mark in the basic application and/or registration, the international application must include a statement that color is claimed as a...

Electronic prescription as contributing factor for hospitalized patients' safety.

Directory of Open Access Journals (Sweden)

Gimenes FRE

2006-03-01

Full Text Available The following study was performed to identify factors related to medication errors in the computerized physician order entry and their advantages and disadvantages according to doctors, nursing team and administrative officers. It is a survey descriptive study carried out at three units of a Brazilian academic hospital in the southeast area. The study was divided in two phases. In the first phase, we analyzed a total of 1,349 prescriptions from general medical unit, surgical and orthopaedic wards during 30 days consecutively. A semi-structured instrument, elaborated by a group of researchers for the study proposals, was used. In the second phase, a semi-structured questionnaire was applied to the health professionals containing closed and open items approaching their opinion about the composition of electronic prescription, the advantages and disadvantages of them, and their suggestions for its improvement. Out of 1,349 prescriptions observed, 17.5% presented deletions, 25.0% medicines written manually and 17.0% of them were incomplete. Some of the advantages pointed by health professionals were its legibility (37.5%, little time spent when elaborating and emitting them (20.5% and the way they are a practical and organized (8%. The disadvantages pointed were repetition of previous prescriptions (34%, typing mistakes (17%, dependence on computers (11% and alterations made manually (7%. We conclude, this way, that the computerized prescription order entry represents a great progress among the strategies used to minimize medication errors caused by prescriptions badly formulated. However, it doesn't eradicate the possibility of medication error occurrences, needing some system modifications.

Dosimetric comparison of lung stereotactic body radiotherapy treatment plans using averaged computed tomography and end-exhalation computed tomography images: Evaluation of the effect of different dose-calculation algorithms and prescription methods

Energy Technology Data Exchange (ETDEWEB)

Mitsuyoshi, Takamasa; Nakamura, Mitsuhiro, E-mail: m_nkmr@kuhp.kyoto-u.ac.jp; Matsuo, Yukinori; Ueki, Nami; Nakamura, Akira; Iizuka, Yusuke; Mampuya, Wambaka Ange; Mizowaki, Takashi; Hiraoka, Masahiro

2016-01-01

The purpose of this article is to quantitatively evaluate differences in dose distributions calculated using various computed tomography (CT) datasets, dose-calculation algorithms, and prescription methods in stereotactic body radiotherapy (SBRT) for patients with early-stage lung cancer. Data on 29 patients with early-stage lung cancer treated with SBRT were retrospectively analyzed. Averaged CT (Ave-CT) and expiratory CT (Ex-CT) images were reconstructed for each patient using 4-dimensional CT data. Dose distributions were initially calculated using the Ave-CT images and recalculated (in the same monitor units [MUs]) by employing Ex-CT images with the same beam arrangements. The dose-volume parameters, including D{sub 95}, D{sub 90}, D{sub 50}, and D{sub 2} of the planning target volume (PTV), were compared between the 2 image sets. To explore the influence of dose-calculation algorithms and prescription methods on the differences in dose distributions evident between Ave-CT and Ex-CT images, we calculated dose distributions using the following 3 different algorithms: x-ray Voxel Monte Carlo (XVMC), Acuros XB (AXB), and the anisotropic analytical algorithm (AAA). We also used 2 different dose-prescription methods; the isocenter prescription and the PTV periphery prescription methods. All differences in PTV dose-volume parameters calculated using Ave-CT and Ex-CT data were within 3 percentage points (%pts) employing the isocenter prescription method, and within 1.5%pts using the PTV periphery prescription method, irrespective of which of the 3 algorithms (XVMC, AXB, and AAA) was employed. The frequencies of dose-volume parameters differing by >1%pt when the XVMC and AXB were used were greater than those associated with the use of the AAA, regardless of the dose-prescription method employed. All differences in PTV dose-volume parameters calculated using Ave-CT and Ex-CT data on patients who underwent lung SBRT were within 3%pts, regardless of the dose

Dosimetric comparison of lung stereotactic body radiotherapy treatment plans using averaged computed tomography and end-exhalation computed tomography images: Evaluation of the effect of different dose-calculation algorithms and prescription methods

International Nuclear Information System (INIS)

Mitsuyoshi, Takamasa; Nakamura, Mitsuhiro; Matsuo, Yukinori; Ueki, Nami; Nakamura, Akira; Iizuka, Yusuke; Mampuya, Wambaka Ange; Mizowaki, Takashi; Hiraoka, Masahiro

2016-01-01

The purpose of this article is to quantitatively evaluate differences in dose distributions calculated using various computed tomography (CT) datasets, dose-calculation algorithms, and prescription methods in stereotactic body radiotherapy (SBRT) for patients with early-stage lung cancer. Data on 29 patients with early-stage lung cancer treated with SBRT were retrospectively analyzed. Averaged CT (Ave-CT) and expiratory CT (Ex-CT) images were reconstructed for each patient using 4-dimensional CT data. Dose distributions were initially calculated using the Ave-CT images and recalculated (in the same monitor units [MUs]) by employing Ex-CT images with the same beam arrangements. The dose-volume parameters, including D 95 , D 90 , D 50 , and D 2 of the planning target volume (PTV), were compared between the 2 image sets. To explore the influence of dose-calculation algorithms and prescription methods on the differences in dose distributions evident between Ave-CT and Ex-CT images, we calculated dose distributions using the following 3 different algorithms: x-ray Voxel Monte Carlo (XVMC), Acuros XB (AXB), and the anisotropic analytical algorithm (AAA). We also used 2 different dose-prescription methods; the isocenter prescription and the PTV periphery prescription methods. All differences in PTV dose-volume parameters calculated using Ave-CT and Ex-CT data were within 3 percentage points (%pts) employing the isocenter prescription method, and within 1.5%pts using the PTV periphery prescription method, irrespective of which of the 3 algorithms (XVMC, AXB, and AAA) was employed. The frequencies of dose-volume parameters differing by >1%pt when the XVMC and AXB were used were greater than those associated with the use of the AAA, regardless of the dose-prescription method employed. All differences in PTV dose-volume parameters calculated using Ave-CT and Ex-CT data on patients who underwent lung SBRT were within 3%pts, regardless of the dose-calculation algorithm or the

Chiropractic claims in the English-speaking world.

Science.gov (United States)

Ernst, Edzard; Gilbey, Andrew

2010-04-09

Some chiropractors and their associations claim that chiropractic is effective for conditions that lack sound supporting evidence or scientific rationale. This study therefore sought to determine the frequency of World Wide Web claims of chiropractors and their associations to treat, asthma, headache/migraine, infant colic, colic, ear infection/earache/otitis media, neck pain, whiplash (not supported by sound evidence), and lower back pain (supported by some evidence). A review of 200 chiropractor websites and 9 chiropractic associations' World Wide Web claims in Australia, Canada, New Zealand, the United Kingdom, and the United States was conducted between 1 October 2008 and 26 November 2008. The outcome measure was claims (either direct or indirect) regarding the eight reviewed conditions, made in the context of chiropractic treatment. We found evidence that 190 (95%) chiropractor websites made unsubstantiated claims regarding at least one of the conditions. When colic and infant colic data were collapsed into one heading, there was evidence that 76 (38%) chiropractor websites made unsubstantiated claims about all the conditions not supported by sound evidence. Fifty-six (28%) websites and 4 of the 9 (44%) associations made claims about lower back pain, whereas 179 (90%) websites and all 9 associations made unsubstantiated claims about headache/migraine. Unsubstantiated claims were made about asthma, ear infection/earache/otitis media, neck pain, The majority of chiropractors and their associations in the English-speaking world seem to make therapeutic claims that are not supported by sound evidence, whilst only 28% of chiropractor websites promote lower back pain, which is supported by some evidence. We suggest the ubiquity of the unsubstantiated claims constitutes an ethical and public health issue.

Patient-perceived content and formatting expectations for prescription container labeling.

Science.gov (United States)

Kebodeaux, Clark D; Peters, Golden L; Kindermann, Heather A; Hurd, Peter D; Berry, Tricia M

2016-01-01

The objectives of the study were to identify patient expectations for prescription label content and formatting and to explore how United States Pharmacopeia Chapter 17 Standards for prescription container labeling meet patient expectations. Focus group. St. Louis, Missouri, in July and August 2014. Patients 18 years and older who were taking at least 2 chronic prescription medications and managing their medications independently. Qualitative themes. Not applicable. Five focus groups (17 total participants) were conducted in St. Louis in 2014. Focus groups were audio-recorded and consent was obtained from the participants. The audio files were professionally transcribed. Atlas.ti software (version 7.5.3) was used to analyze the transcript data, which were then coded to identify key themes. To ensure consistency of interpretation, a constant comparative analytic framework approach was used. Analysis produced 6 themes related to patient perceptions and expectations of prescription label content and formatting: importance of drug name, dose, and directions; lack of side effects on the label; improved organization and larger font size; using the color red; lack of familiarity with auxiliary labels; and the importance of pharmacy information. Themes focused on how patients use prescription labels and the relative value of different aspects of prescription container labeling. Patient-perceived prescription content and formatting expectations for prescription container labeling were generally consistent with published USP Chapter 17 guidelines. The importance of pharmacy phone numbers, white space, and highlighting were noteworthy. Copyright © 2016 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

Medication errors: prescribing faults and prescription errors.

Science.gov (United States)

Velo, Giampaolo P; Minuz, Pietro

2009-06-01

1. Medication errors are common in general practice and in hospitals. Both errors in the act of writing (prescription errors) and prescribing faults due to erroneous medical decisions can result in harm to patients. 2. Any step in the prescribing process can generate errors. Slips, lapses, or mistakes are sources of errors, as in unintended omissions in the transcription of drugs. Faults in dose selection, omitted transcription, and poor handwriting are common. 3. Inadequate knowledge or competence and incomplete information about clinical characteristics and previous treatment of individual patients can result in prescribing faults, including the use of potentially inappropriate medications. 4. An unsafe working environment, complex or undefined procedures, and inadequate communication among health-care personnel, particularly between doctors and nurses, have been identified as important underlying factors that contribute to prescription errors and prescribing faults. 5. Active interventions aimed at reducing prescription errors and prescribing faults are strongly recommended. These should be focused on the education and training of prescribers and the use of on-line aids. The complexity of the prescribing procedure should be reduced by introducing automated systems or uniform prescribing charts, in order to avoid transcription and omission errors. Feedback control systems and immediate review of prescriptions, which can be performed with the assistance of a hospital pharmacist, are also helpful. Audits should be performed periodically.

An Evidence-Based Approach To Exercise Prescriptions on ISS

Science.gov (United States)

Ploutz-Snyder, Lori

2009-01-01

This presentation describes current exercise countermeasures and exercise equipment for astronauts onboard the ISS. Additionally, a strategy for evaluating evidence supporting spaceflight exercise is described and a new exercise prescription is proposed. The current exercise regimen is not fully effective as the ISS exercise hardware does not allow for sufficient exercise intensity, the exercise prescription is adequate and crew members are noncompliant with the prescription. New ISS hardware is proposed, Advanced Resistance Exercise Device (ARED), which allows additional exercises, is instrumented for data acquisition and offers improved loading. The new T2 hardware offers a better harness and subject loading system, is instrumented to allow ground reaction force data, and offers improved speed. A strategy for developing a spaceflight exercise prescription is described and involves identifying exercise training programs that have been shown to maximize adaptive benefits of people exercising in both 0 and 1 g environments. Exercise intensity emerged as an important factor in maintaining physiologic adaptations in the spaceflight environment and interval training is suggested. New ISS exercise hardware should allow for exercise at intensities high enough to elicit adaptive responses. Additionally, new exercise prescriptions should incorporate higher intensity exercises and seek to optimize intensity, duration and frequency for greater efficiency.

Risk Factors for Serious Prescription Opioid-Induced Respiratory Depression or Overdose: Comparison of Commercially Insured and Veterans Health Affairs Populations.

Science.gov (United States)

Nadpara, Pramit A; Joyce, Andrew R; Murrelle, E Lenn; Carroll, Nathan W; Carroll, Norman V; Barnard, Marie; Zedler, Barbara K

2018-01-01

To characterize the risk factors associated with overdose or serious opioid-induced respiratory depression (OIRD) among medical users of prescription opioids in a commercially insured population (CIP) and to compare risk factor profiles between the CIP and Veterans Health Administration (VHA) population. Analysis of data from 18,365,497 patients in the IMS PharMetrics Plus health plan claims database (CIP) who were dispensed a prescription opioid in 2009 to 2013. Baseline factors associated with an event of serious OIRD among 7,234 cases and 28,932 controls were identified using multivariable logistic regression. The CIP risk factor profile was compared with that from a corresponding logistic regression among 817 VHA cases and 8,170 controls in 2010 to 2012. The strongest associations with serious OIRD in CIP were diagnosed substance use disorder (odds ratio [OR] = 10.20, 95% confidence interval [CI] = 9.06-11.40) and depression (OR = 3.12, 95% CI = 2.84-3.42). Other strongly associated factors included other mental health disorders; impaired liver, renal, vascular, and pulmonary function; prescribed fentanyl, methadone, and morphine; higher daily opioid doses; and concurrent psychoactive medications. These risk factors, except depression, vascular disease, and specific opioids, largely aligned with VHA despite CIP being substantially younger, including more females and less chronic disease, and having greater prescribing prevalence of higher daily opioid doses, specific opioids, and most selected nonopioids. Risk factor profiles for serious OIRD among US medical users of prescription opioids with private or public health insurance were largely concordant despite substantial differences between the populations in demographics, clinical conditions, health care delivery systems, and clinical practices. © 2017 American Academy of Pain Medicine.

Use of major surgery in south India: A retrospective audit of hospital claim data from a large, community health insurance program.

Science.gov (United States)

Shaikh, Maaz; Woodward, Mark; Rahimi, Kazem; Patel, Anushka; Rath, Santosh; MacMahon, Stephen; Jha, Vivekanand

2015-05-01

Information on the use of major surgery in India is scarce. In this study we aimed to bridge this gap by auditing hospital claims from Rajiv Aarogyasri Community Health Insurance Scheme, which provides access to free hospital care through state-funded insurance to 68 million beneficiaries, an estimated 81% of population in the states of Telangana and Andhra Pradesh. Publicly available deidentified hospital claim data for all surgery procedures conducted between mid-2008 and mid-2012 were compiled across all 23 districts in Telangana and Andhra Pradesh. A total of 677,332 operative admissions (80% at private hospitals) were recorded at an annual rate of 259 per 100,000 beneficiaries, with male subjects accounting for 56% of admissions. Injury was the most common cause for operative admission (27%) with operative correction of long bone fractures being the most common procedure (20%) identified in the audit. Diseases of the digestive (16%), genitourinary (12%), and musculoskeletal (10%) systems were other leading causes for operative admissions. Most hospital bed-days were used by admissions for injuries (31%) and diseases of the digestive (17%) and musculoskeletal system (11%) costing 19%, 13%, and 11% of reimbursement. Operations on the circulatory system (8%) accounted for 21% of reimbursements. Annual per capita cost of operative claims was US$1.48. The use of surgery by an insured population in India continued to be low despite access to financing comparable with greater spending countries, highlighting need for strategies, beyond traditional health financing, that prioritize improvement in access, delivery, and use of operative care. Copyright © 2015 Elsevier Inc. All rights reserved.

12 CFR 627.2750 - Priority of claims-banks.

Science.gov (United States)

2010-01-01

...) All claims for taxes. (f) All claims of creditors which are secured by specific assets or equities of... accordance with priorities of applicable Federal or State law. (g) All claims of holders of bonds issued by... claims of holders of consolidated and System-wide bonds and all claims of the other Farm Credit banks...

[Prescription drug consumption recovery following the co-payment change: Evidence from a regional health service].

Science.gov (United States)

Sánchez, Diego P; Guillén, José J; Torres, Alberto M; Arense, Julián J; López, Ángel; Sánchez, Fernando I

2015-01-01

In the past few decades, increasing pharmaceutical expenditures in Spain and other western countries led to the adoption of reforms in order to reduce this trend. The aim of our study was to analyze if reforms concerning the pharmaceutical reimbursement scheme in Spain have been associated with changes in the volume and trend of pharmaceutical consumption. Retrospective observational study. Region of Murcia. Prescription drug in primary care and external consultations. Records of prescribed medicines between January 1, 2008 and December 31, 2013. Segmented regression analysis of interrupted time-series of prescription drug consumption. Dispensing of all five therapeutic classes fell immediately after co-payment changes. The segmented regression model suggested that per patient drug consumption in pensioners may have decreased by about 6.76% (95% CI; -8.66% to -5.19%) in the twelve months after the reform, compared with the absence of such a policy. Furthermore the slope of the series of consumption increased from 6.08 (P<.001) to 12.17 (P<.019). The implementation of copayment policies could be associated with a significant decrease in the level of prescribed drug use in Murcia Region, but this effect seems to have been only temporary in the five therapeutic groups analyzed, since almost simultaneously there has been an increase in the growth trend. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

Prevalence of antibiotic prescription in southern Italian outpatients: real-world data analysis of socioeconomic and sociodemographic variables at a municipality level.

Science.gov (United States)

Russo, Veronica; Monetti, Valeria Marina; Guerriero, Francesca; Trama, Ugo; Guida, Antonella; Menditto, Enrica; Orlando, Valentina

2018-01-01

The aim of this study was to analyze the geographic variation in systemic antibiotic prescription at a regional level and to explore the influence of socioeconomic and sociodemographic variables. This study was a retrospective analysis of reimbursement pharmacy records in the outpatient settings of Italy's Campania Region in 2016. Standardized antibiotic prescription rates were calculated at municipality and Local Health Unit (LHU) level. Antibiotic consumption was analyzed as defined daily doses (DDD)/1000 inhabitants per day (DID). Logistic regression was performed to evaluate the association between antibiotic prescription and sociodemographic and socioeconomic determinants at a municipality level. The average antibiotic prevalence rate was 46.8%. At LHU level, the age-adjusted prevalence rates ranged from 41.1% in Benevento to 51.0% in Naples2. Significant differences were found among municipalities, from 15.2% in Omignano (Salerno LHU [Sa-LHU]) to 61.9% in Moschiano (Avellino [Av-LHU]). The geographic distribution also showed significant differences in terms of antibiotic consumption, from 6.7 DID in Omignano to 41.6 in San Marcelino (Caserta [Ce-LHU]). Logistic regression showed that both municipality type and average annual income level were the main determinants of antibiotic prescription. Urban municipalities were more than eight times as likely to have antibiotic high prevalence rates compared to rural municipalities (adjusted odds ratio [OR]: 8.62; 95% confidence interval [CI]: 4.06-18.30, P <0.001). Low average annual income level municipalities were more than eight times as likely to have antibiotic high prevalence rates compared to high average annual income level municipalities (adjusted OR: 8.48; 95% CI: 3.45-20.81, P <0.001). We provide a snapshot of Campania's antibiotic consumption, evidencing the impact of both socioeconomic and sociodemographic factors on the prevalence of antibiotic prescription. The observed intraregional variability

Preventing Prescription Drug Abuse in Adolescence: A Collaborative Approach

Science.gov (United States)

Jones, Beth A.; Fullwood, Harry; Hawthorn, Melissa

2012-01-01

With the growing awareness of adolescent prescription drug abuse, communities and schools are beginning to explore prevention and intervention strategies which are appropriate for their youth. This article provides a framework for developing a collaborative approach to prescription drug abuse prevention--called the Prevention Awareness Team--that…

The light-cone gauge and the principal value prescription

International Nuclear Information System (INIS)

Pimentel, B.M.; Suzuki, A.T.

1988-01-01

The principal value prescription is used to treat the unphysical pole (K.n) -1 in the basic one-loop light-cone integral. It is shown that the prescription is well suited to such a task, contrary to what has been previously thought till now. (author) [pt

Determinants of U.S. Prescription Drug Utilization using County Level Data.

Science.gov (United States)

Nianogo, Thierry; Okunade, Albert; Fofana, Demba; Chen, Weiwei

2016-05-01

Prescription drugs are the third largest component of U.S. healthcare expenditures. The 2006 Medicare Part D and the 2010 Affordable Care Act are catalysts for further growths in utilization becuase of insurance expansion effects. This research investigating the determinants of prescription drug utilization is timely, methodologically novel, and policy relevant. Differences in population health status, access to care, socioeconomics, demographics, and variations in per capita number of scripts filled at retail pharmacies across the U.S.A. justify fitting separate econometric models to county data of the states partitioned into low, medium, and high prescription drug users. Given the skewed distribution of per capita number of filled prescriptions (response variable), we fit the variance stabilizing Box-Cox power transformation regression models to 2011 county level data for investigating the correlates of prescription drug utilization separately for low, medium, and high utilization states. Maximum likelihood regression parameter estimates, including the optimal Box-Cox λ power transformations, differ across high (λ = 0.214), medium (λ = 0.942), and low (λ = 0.302) prescription drug utilization models. The estimated income elasticities of -0.634, 0.031, and -0.532 in high, medium, and low utilization models suggest that the economic behavior of prescriptions is not invariant across different utilization levels. Copyright © 2015 John Wiley & Sons, Ltd.

Pricing of prescription drugs and its impact on physicians' choice behavior.

Science.gov (United States)

Miao-Sheng, Chen; Yu-Ti, Shih

2008-09-01

This research presents an analysis of Taiwan's health care market with the focus on the pricing of prescription drugs and its impact on physicians' choice behavior. Since the advent of Taiwan's national health insurance, with the competent authority being Bureau of National Health Insurance (BNHI), hospitals are allowed to sell prescription drugs to patients at prices above the purchasing prices, so each prescription drug has two prices: one at which drugs are sold to hospitals; the other which BNHI reimbursement to hospitals. The margin between the different prices is the sales discount that pharmaceutical companies offer to the hospitals. We find that sales discount has a great impact on physicians' choice behavior: i.e., physicians are price-sensitive to prescription drugs. In addition, it is found that too high a sales discount of a prescription drug would result in a too low weighted average price of that drug sold; thus BNHI would be more likely to adjust downward the rate it reimbursement to the hospital. This presents a sales strategy problem to pharmaceutical companies. To solve this, we use the distribution of physicians' evaluations of prescription drugs to establish a profit maximization model in hopes of helping companies to price drugs and find the optimal promotion expending. Ten popular prescription drugs are used in this research as examples.

Prevalence and pattern of prescription errors in a Nigerian kidney ...

African Journals Online (AJOL)

Setting: Kidney Care Centre is a public Specialist hospital. ... Main outcome measures: Prevalence of prescription errors, pattern of prescription errors, pharmacist's intervention. ... A medication quality assurance unit is needed in our hospitals.

Analysis of prescription database extracted from standard textbooks of traditional Dai medicine.

Science.gov (United States)

Zhang, Chuang; Chongsuvivatwong, Virasakdi; Keawpradub, Niwat; Lin, Yanfang

2012-08-29

Traditional Dai Medicine (TDM) is one of the four major ethnomedicine of China. In 2007 a group of experts produced a set of seven Dai medical textbooks on this subject. The first two were selected as the main data source to analyse well recognized prescriptions. To quantify patterns of prescriptions, common ingredients, indications and usages of TDM. A relational database linking the prescriptions, ingredients, herb names, indications, and usages was set up. Frequency of pattern of combination and common ingredients were tabulated. A total of 200 prescriptions and 402 herbs were compiled. Prescriptions based on "wind" disorders, a detoxification theory that most commonly deals with symptoms of digestive system diseases, accounted for over one third of all prescriptions. The major methods of preparations mostly used roots and whole herbs. The information extracted from the relational database may be useful for understanding symptomatic treatments. Antidote and detoxification theory deserves further research.

Proscriptive versus prescriptive morality: two faces of moral regulation.

Science.gov (United States)

Janoff-Bulman, Ronnie; Sheikh, Sana; Hepp, Sebastian

2009-03-01

A distinction is made between two forms of morality on the basis of approach-avoidance differences in self-regulation. Prescriptive morality is sensitive to positive outcomes, activation-based, and focused on what we should do. Proscriptive morality is sensitive to negative outcomes, inhibition-based, and focused on what we should not do. Seven studies profile these two faces of morality, support their distinct motivational underpinnings, and provide evidence of moral asymmetry. Both are well-represented in individuals' moral repertoire and equivalent in terms of moral weight, but proscriptive morality is condemnatory and strict, whereas prescriptive morality is commendatory and not strict. More specifically, in these studies proscriptive morality was perceived as concrete, mandatory, and duty-based, whereas prescriptive morality was perceived as more abstract, discretionary, and based in duty or desire; proscriptive immorality resulted in greater blame, whereas prescriptive morality resulted in greater moral credit. Implications for broader social regulation, including cross-cultural differences and political orientation, are discussed.

Nutrition labelling, marketing techniques, nutrition claims and health claims on chip and biscuit packages from sixteen countries.

Science.gov (United States)

Mayhew, Alexandra J; Lock, Karen; Kelishadi, Roya; Swaminathan, Sumathi; Marcilio, Claudia S; Iqbal, Romaina; Dehghan, Mahshid; Yusuf, Salim; Chow, Clara K

2016-04-01

Food packages were objectively assessed to explore differences in nutrition labelling, selected promotional marketing techniques and health and nutrition claims between countries, in comparison to national regulations. Cross-sectional. Chip and sweet biscuit packages were collected from sixteen countries at different levels of economic development in the EPOCH (Environmental Profile of a Community's Health) study between 2008 and 2010. Seven hundred and thirty-seven food packages were systematically evaluated for nutrition labelling, selected promotional marketing techniques relevant to nutrition and health, and health and nutrition claims. We compared pack labelling in countries with labelling regulations, with voluntary regulations and no regulations. Overall 86 % of the packages had nutrition labels, 30 % had health or nutrition claims and 87 % displayed selected marketing techniques. On average, each package displayed two marketing techniques and one health or nutrition claim. In countries with mandatory nutrition labelling a greater proportion of packages displayed nutrition labels, had more of the seven required nutrients present, more total nutrients listed and higher readability compared with those with voluntary or no regulations. Countries with no health or nutrition claim regulations had fewer claims per package compared with countries with regulations. Nutrition label regulations were associated with increased prevalence and quality of nutrition labels. Health and nutrition claim regulations were unexpectedly associated with increased use of claims, suggesting that current regulations may not have the desired effect of protecting consumers. Of concern, lack of regulation was associated with increased promotional marketing techniques directed at children and misleadingly promoting broad concepts of health.

Variations in non-prescription drug consumption and expenditure: Determinants and policy implications.

Science.gov (United States)

Otto, Monica; Armeni, Patrizio; Jommi, Claudio

2018-01-31

This paper analyses the determinants of cross-regional variations in expenditure and consumption for non-prescription drugs using the Italian Health Care Service as a case study. This research question has never been posed in other literature contributions. Per capita income, the incidence of elderly people, the presence of distribution points alternative to community pharmacies (para-pharmacies and drug corners in supermarkets), and the disease prevalence were included as possible explanatory variables. A trade-off between consumption of non-prescription and prescription-only drugs was also investigated. Correlation was tested through linear regression models with regional fixed-effects. Demand-driven variables, including the prevalence of the target diseases and income, were found to be more influential than supply-side variables, such as the presence of alternative distribution points. Hence, the consumption of non-prescription drugs appears to respond to needs and is not induced by the supply. The expected trade-off between consumption for prescription-only and non-prescription drugs was not empirically found: increasing the use of non-prescription drugs did not automatically imply savings on prescription-only drugs covered by third payers. Despite some caveats (the short period of time covered by the longitudinal data and some missing monthly data), the regression model revealed a high explanatory power of the variability and a strong predictive ability of future values. Copyright © 2018 Elsevier B.V. All rights reserved.

Prescription writing practices in a rural tertiary care hospital in Western Maharashtra, India

Directory of Open Access Journals (Sweden)

Vaishali D Phalke

2011-01-01

Full Text Available BackgroundPrescription is a written order from physician to pharmacistwhich contains name of drug, its dose and its method ofdispensing and advice over consuming it. The frequency ofdrug prescription errors is high. Prescribing errorcontributes significantly towards adverse drug events. Thepresent study was undertaken to understand the currentprescription writing practices and to detect the commonerrors in them at a tertiary health care centre situated in arural area of Western Maharashtra, India.MethodA cross sectional study was conducted at a tertiary levelhospital located at a rural area of Maharashtra state, Indiaduring October 2009-March 2010. 499 prescriptions comingto medical store during period of one month wereconsidered for data analysis. Important informationregarding the patient, doctor, drug and the generaldescription of the prescription were obtained.ResultsAll the prescriptions were on the hospital pad. A significantnumber of the prescriptions (n=88, 17.6% were written inillegible handwriting and not easily readable. The name, ageand sex of the patient were mentioned is majority of theprescriptions. All the prescriptions (100% failed todemonstrate the presence of address, height and weight ofthe patient. Only the brand name of the drugs wasmentioned in all the prescriptions with none of them havingthe generic name. The strength, quantity and route ofadministration of the drug were found on 73.1%, 65.3% and75.2% prescriptions.ConclusionThere are widespread errors in prescription writing by thedoctors. Educational intervention programs and use ofcomputer can substantially contribute in the lowering ofsuch errors. A short course on prescription writing beforethe medical student enters the clinical field and strictmonitoring by the administrative authorities may also helpalleviate the problem.Word count: 2980Tables: 2

A multileaf collimator field prescription preparation system for conventional radiotherapy

International Nuclear Information System (INIS)

Du, M.N.; Yu, C. X.; Symons, M.; Yan, D.; Taylor, R.; Matter, R.C.; Gustafson, G.; Martinez, A.; Wong, J.W.

1995-01-01

Purpose: The purpose of this work is to develop a prescription preparation system for efficient field shaping using a multileaf collimator that can be used in community settings as well as research institutions. The efficiency advantage of the computer-controlled multileaf collimator, over cerrobend blocks, to shape radiation fields has been shown in conformal treatments, which typically require complete volumetric computerized tomographic data for three-dimensional radiation treatment planning--a utility not readily available to the general community. As a result, most patients today are treated with conventional radiation therapy. Therefore, we believe that it is very important to fully use the same efficiency advantage of multileaf collimator as a block replacement in conventional practice. Methods and Material: The multileaf collimator prescription preparation system developed by us acquires prescription images from different sources, including film scanner and radiation treatment planning systems. The multileaf collimator angle and leaf positions are set from the desired field contour defined on the prescription image, by minimizing the area discrepancies. Interactive graphical tools include manual adjustment of collimator angle and leaf positions, and definition of portions of the field edges that require maximal conformation. Data files of the final leaf positions are transferred to the multileaf collimator controller via a dedicated communication link. Results: We have implemented the field prescription preparation system and a network model for integrating the multileaf collimator and other radiotherapy modalities for routine treatments. For routine plan evaluation, isodose contours measured with film in solid water phantom at prescription depth are overlaid on the prescription image. Preliminary study indicates that the efficiency advantage of the MLC over cerrobend blocks in conformal therapy also holds true for conventional treatments. Conclusion: Our

Twelve years' experience with direct-to-consumer advertising of prescription drugs in Canada: a cautionary tale.

Directory of Open Access Journals (Sweden)

Barbara Mintzes

2009-05-01

Full Text Available Direct-to-consumer advertising (DTCA of prescription drugs is illegal in Canada as a health protection measure, but is permitted in the United States. However, in 2000, Canadian policy was changed to allow 'reminder' advertising of prescription drugs. This is a form of advertising that states the brand name without health claims. 'Reminder' advertising is prohibited in the US for drugs that have 'black box' warnings of serious risks. This study examines spending on DTCA in Canada from 1995 to 2006, 12 years spanning this policy shift. We ask how annual per capita spending compares to that in the US, and whether drugs with Canadian or US regulatory safety warnings are advertised to the Canadian public in reminder advertising.Prescription drug advertising spending data were extracted from a data set on health sector spending in Canada obtained from a market research company, TNS Media Inc. Spending was adjusted for inflation and compared with US spending. Inflation-adjusted spending on branded DTCA in Canada grew from under CAD$2 million per year before 1999 to over $22 million in 2006. The major growth was in broadcast advertising, accounting for 83% of spending in 2006. US annual per capita spending was on average 24 times Canadian levels. Celebrex (celecoxib, which has a US black box and was subject to three safety advisories in Canada, was the most heavily advertised drug on Canadian television in 2005 and 2006. Of 8 brands with >$500,000 spending, which together accounted for 59% of branded DTCA in all media, 6 were subject to Canadian safety advisories, and 4 had US black box warnings.Branded 'reminder' advertising has grown rapidly in Canada since 2000, mainly due to a growth in television advertising. Although DTCA spending per capita is much lower in Canada than in the US, there is no evidence of safer content or product choice; many heavily-advertised drugs in Canada have been subject to safety advisories. For governments searching for

Twelve years' experience with direct-to-consumer advertising of prescription drugs in Canada: a cautionary tale.

Science.gov (United States)

Mintzes, Barbara; Morgan, Steve; Wright, James M

2009-05-27

Direct-to-consumer advertising (DTCA) of prescription drugs is illegal in Canada as a health protection measure, but is permitted in the United States. However, in 2000, Canadian policy was changed to allow 'reminder' advertising of prescription drugs. This is a form of advertising that states the brand name without health claims. 'Reminder' advertising is prohibited in the US for drugs that have 'black box' warnings of serious risks. This study examines spending on DTCA in Canada from 1995 to 2006, 12 years spanning this policy shift. We ask how annual per capita spending compares to that in the US, and whether drugs with Canadian or US regulatory safety warnings are advertised to the Canadian public in reminder advertising. Prescription drug advertising spending data were extracted from a data set on health sector spending in Canada obtained from a market research company, TNS Media Inc. Spending was adjusted for inflation and compared with US spending. Inflation-adjusted spending on branded DTCA in Canada grew from under CAD$2 million per year before 1999 to over $22 million in 2006. The major growth was in broadcast advertising, accounting for 83% of spending in 2006. US annual per capita spending was on average 24 times Canadian levels. Celebrex (celecoxib), which has a US black box and was subject to three safety advisories in Canada, was the most heavily advertised drug on Canadian television in 2005 and 2006. Of 8 brands with >$500,000 spending, which together accounted for 59% of branded DTCA in all media, 6 were subject to Canadian safety advisories, and 4 had US black box warnings. Branded 'reminder' advertising has grown rapidly in Canada since 2000, mainly due to a growth in television advertising. Although DTCA spending per capita is much lower in Canada than in the US, there is no evidence of safer content or product choice; many heavily-advertised drugs in Canada have been subject to safety advisories. For governments searching for compromise

76 FR 36176 - Fully Developed Claim (Fully Developed Claims-Applications for Compensation, Pension, DIC, Death...

Science.gov (United States)

2011-06-21

... DEPARTMENT OF VETERANS AFFAIRS [OMB Control No. 2900-0747] Fully Developed Claim (Fully Developed Claims--Applications for Compensation, Pension, DIC, Death Pension, and/or Accrued Benefits); Correction AGENCY: Veterans Benefits Administration, Department of Veterans Affairs. ACTION: Notice; correction...

Sales promotion by wholesalers affects general practitioners' prescription behaviours in Japan.

Science.gov (United States)

Shimura, Hirohisa

2018-01-01

Background : One method for promoting drugs in Japan has been utilizing wholesalers for promotion; however, the effectiveness of the sales promotion has been brought into question. Methods : A total of 74,552 responses were collected from an internet survey of 511 prescribing doctors in hospitals with less than 19 beds, which recalled the visits by wholesalers' sales representatives (MS) in 2014. Each assessed the degree to which MS and/or sales representatives from a pharmaceutical company (MR) influenced a decision to prescribe each drug. The responses were analysed using the chi-square test and Goodman-Kruskal's gamma to evaluate the association between MS calls and doctors' prescription orders. Results : Results showed a significant effect of the MS calls on doctors' behaviours in terms of new drug prescriptions and subsequent behaviours. The results by therapeutic category showed a similar strong influence of the joint calls on new prescriptions on some therapeutic classes. The MS calls significantly influenced doctors to maintain and increase the prescription volume (p sales promotion on the part of MSs and MRs adds value to the prescription decisions. Moreover, results suggest that MSs enhance prescription outcomes in competitive therapeutic categories.

Retrospective Analysis of Inflight Exercise Loading and Physiological Outcomes

Science.gov (United States)

Ploutz-Snyder, L. L.; Buxton, R. E.; De Witt, J. K.; Guilliams, M. E.; Hanson, A. M.; Peters, B. T.; Pandorf, M. M. Scott; Sibonga, J. D.

2014-01-01

Astronauts perform exercise throughout their missions to counter the health declines that occur as a result of long-term exposure to weightlessness. Although all astronauts perform exercise during their missions, the specific prescriptions, and thus the mechanical loading, differs among individuals. For example, inflight ground reaction force data indicate that subject-specific differences exist in foot forces created when exercising on the second-generation treadmill (T2) [1]. The current exercise devices allow astronauts to complete prescriptions at higher intensities, resulting in greater benefits with increased efficiency. Although physiological outcomes have improved, the specific factors related to the increased benefits are unknown. In-flight exercise hardware collect data that allows for exploratory analyses to determine if specific performance factors relate to physiological outcomes. These analyses are vital for understanding which components of exercise are most critical for optimal human health and performance. The relationship between exercise performance variables and physiological changes during flight has yet to be fully investigated. Identifying the critical performance variables that relate to improved physiological outcomes is vital for creating current and future exercise prescriptions to optimize astronaut health. The specific aims of this project are: 1) To quantify the exercise-related mechanical loading experienced by crewmembers on T2 and ARED during their mission on ISS; 2) To explore relationships between exercise loading variables, bone, and muscle health changes during the mission; 3) To determine if specific mechanical loading variables are more critical than others in protecting physiology; 4) To develop methodology for operational use in monitoring accumulated training loads during crew exercise programs. This retrospective analysis, which is currently in progress, is being conducted using data from astronauts that have flown long

Automated Individual Prescription of Exercise with an XML-based Expert System.

Science.gov (United States)

Jang, S; Park, S R; Jang, Y; Park, J; Yoon, Y; Park, S

2005-01-01

Continuously motivating people to exercise regularly is more important than finding a barriers such as lack of time, cost of equipment or gym membership, lack of nearby facilities and poor weather or night-time lighting. Our proposed system presents practicable methods of motivation through a web-based exercise prescription service. Users are instructed to exercise according to their physical ability by means of an automated individual prescription of exercise checked and approved by a personal trainer or exercise specialist after being tested with the HIMS, fitness assessment system. Furthermore, utilizing BIOFIT exercise prescriptions scheduled by an expert system can help users exercise systematically. Automated individual prescriptions are built in XML based documents because the data needs to be flexible, expansible and convertible structures to process diverse exercise templates. Web-based exercise prescription service makes users stay interested in exercise even if they live in many different environments.

Can antibiotic prescriptions in respiratory tract infections be improved? A cluster-randomized educational intervention in general practice – The Prescription Peer Academic Detailing (Rx-PAD Study [NCT00272155

Directory of Open Access Journals (Sweden)

Rognstad Sture

2006-06-01

Full Text Available Abstract Background More than half of all antibiotic prescriptions in general practice are issued for respiratory tract infections (RTIs, despite convincing evidence that many of these infections are caused by viruses. Frequent misuse of antimicrobial agents is of great global health concern, as we face an emerging worldwide threat of bacterial antibiotic resistance. There is an increasing need to identify determinants and patterns of antibiotic prescribing, in order to identify where clinical practice can be improved. Methods/Design Approximately 80 peer continuing medical education (CME groups in southern Norway will be recruited to a cluster randomized trial. Participating groups will be randomized either to an intervention- or a control group. A multifaceted intervention has been tailored, where key components are educational outreach visits to the CME-groups, work-shops, audit and feedback. Prescription Peer Academic Detailers (Rx-PADs, who are trained GPs, will conduct the educational outreach visits. During these visits, evidence-based recommendations of antibiotic prescriptions for RTIs will be presented and software will be handed out for installation in participants PCs, enabling collection of prescription data. These data will subsequently be linked to corresponding data from the Norwegian Prescription Database (NorPD. Individual feedback reports will be sent all participating GPs during and one year after the intervention. Main outcomes are baseline proportion of inappropriate antibiotic prescriptions for RTIs and change in prescription patterns compared to baseline one year after the initiation of the tailored pedagogic intervention. Discussion Improvement of prescription patterns in medical practice is a challenging task. A thorough evaluation of guidelines for antibiotic treatment in RTIs may impose important benefits, whereas inappropriate prescribing entails substantial costs, as well as undesirable consequences like development

Understanding Nonprescription and Prescription Drug Misuse in Late Adolescence/Young Adulthood

Directory of Open Access Journals (Sweden)

Sasha A. Fleary

2013-01-01

Full Text Available This study explored the extent to which nonprescription and prescription drugs misuse among adolescents/young adults are related to their perception that it is safer than illicit drugs, ease of access, and lower societal stigma. Adolescents/young adults (; , completed an online survey about their nonprescription and prescription drug misuse, other substance use, and correlates of use. Perceived risk, societal stigma, and access to nonprescription and prescription drugs were predictive of misuse. Results support program planners working towards targeting perceived risk and societal stigma in reducing misuse and the need to restrict and monitor access to nonprescription and prescription drugs for adolescents/young adults.

Deregulation of allopathic prescription and medical practice in India: Benefits and pitfalls

Directory of Open Access Journals (Sweden)

Raman Kumar

2016-01-01

Full Text Available In the background of debates on Universal Health Coverage, skill transfer from the medical practice license holders to other health-care providers such as nurse practitioner has become a global norm. In India, where the world's largest numbers of medical graduates are produced, this discussion is expanding to extremes and serious suggestions are coming forward for the development of legal framework for allowing dentists, homeopaths, pharmacists, and half duration trained doctors; permission to issue allopathic prescription. Allopathic medical prescription. It is noteworthy that this discussion only pertains to the pharmaceutical products retailed through “allopathic medical prescriptions.” A prescription is not only advice for patient's recovery but it also is a legitimate order for the sale of controlled drugs and pharmaceutical product; thereby functions as a regulatory tool for consumption of pharmaceutical products at retail level. Who is ultimately going to benefit from this prescription deregulation? This editorial explores benefits and pitfalls of prescription and medical practice deregulation.

Analysis of prescription database extracted from standard textbooks of traditional Dai medicine

Directory of Open Access Journals (Sweden)

Zhang Chuang

2012-08-01

Full Text Available Abstract Background Traditional Dai Medicine (TDM is one of the four major ethnomedicine of China. In 2007 a group of experts produced a set of seven Dai medical textbooks on this subject. The first two were selected as the main data source to analyse well recognized prescriptions. Objective To quantify patterns of prescriptions, common ingredients, indications and usages of TDM. Methods A relational database linking the prescriptions, ingredients, herb names, indications, and usages was set up. Frequency of pattern of combination and common ingredients were tabulated. Results A total of 200 prescriptions and 402 herbs were compiled. Prescriptions based on "wind" disorders, a detoxification theory that most commonly deals with symptoms of digestive system diseases, accounted for over one third of all prescriptions. The major methods of preparations mostly used roots and whole herbs. Conclusion The information extracted from the relational database may be useful for understanding symptomatic treatments. Antidote and detoxification theory deserves further research.

Nature of Medical Malpractice Claims Against Radiation Oncologists

Energy Technology Data Exchange (ETDEWEB)

Marshall, Deborah; Tringale, Kathryn [Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California (United States); Connor, Michael [Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California (United States); University of California Irvine School of Medicine, Irvine, California (United States); Punglia, Rinaa [Department of Radiation Oncology, Brigham and Women' s Hospital, Harvard Medical School, Boston, Massachusetts (United States); Recht, Abram [Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (United States); Hattangadi-Gluth, Jona, E-mail: jhattangadi@ucsd.edu [Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California (United States)

2017-05-01

Purpose: To examine characteristics of medical malpractice claims involving radiation oncologists closed during a 10-year period. Methods and Materials: Malpractice claims filed against radiation oncologists from 2003 to 2012 collected by a nationwide liability insurance trade association were analyzed. Outcomes included the nature of claims and indemnity payments, including associated presenting diagnoses, procedures, alleged medical errors, and injury severity. We compared the likelihood of a claim resulting in payment in relation to injury severity categories (death as referent) using binomial logistic regression. Results: There were 362 closed claims involving radiation oncology, 102 (28%) of which were paid, resulting in $38 million in indemnity payments. The most common alleged errors included “improper performance” (38% of closed claims, 18% were paid; 29% [$11 million] of total indemnity), “errors in diagnosis” (25% of closed claims, 46% were paid; 44% [$17 million] of total indemnity), and “no medical misadventure” (14% of closed claims, 8% were paid; less than 1% [$148,000] of total indemnity). Another physician was named in 32% of claims, and consent issues/breach of contract were cited in 18%. Claims for injury resulting in death represented 39% of closed claims and 25% of total indemnity. “Improper performance” was the primary alleged error associated with injury resulting in death. Compared with claims involving death, major temporary injury (odds ratio [OR] 2.8, 95% confidence interval [CI] 1.29-5.85, P=.009), significant permanent injury (OR 3.1, 95% CI 1.48-6.46, P=.003), and major permanent injury (OR 5.5, 95% CI 1.89-16.15, P=.002) had a higher likelihood of a claim resulting in indemnity payment. Conclusions: Improper performance was the most common alleged malpractice error. Claims involving significant or major injury were more likely to be paid than those involving death. Insights into the nature of liability claims against

21 CFR 1306.05 - Manner of issuance of prescriptions.

Science.gov (United States)

2010-04-01

... 21 Food and Drugs 9 2010-04-01 2010-04-01 false Manner of issuance of prescriptions. 1306.05 Section 1306.05 Food and Drugs DRUG ENFORCEMENT ADMINISTRATION, DEPARTMENT OF JUSTICE PRESCRIPTIONS... revised, effective June 1, 2010. For the convenience of the user, therevised text is set forth as follows...

Drug prescription pattern in a Nigerian Teaching Hospital | Sodipo ...

African Journals Online (AJOL)

Background: There is an increasing incidence of irrational drug use worldwide. The drug prescription pattern in Nigeria is characterised by inappropriate drug use which has led to increasing expenditure and loss of patient confidence in the health sector. This has led to calls to improve prescription patterns in Nigerian ...

Prediction of Change in Prescription Ingredient Costs and Co-payment Rates under a Reference Pricing System in South Korea.

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Heo, Ji Haeng; Rascati, Karen L; Lee, Eui-Kyung

2017-05-01

The reference pricing system (RPS) establishes reference prices within interchangeable reference groupings. For drugs priced higher than the reference point, patients pay the difference between the reference price and the total price. To predict potential changes in prescription ingredient costs and co-payment rates after implementation of an RPS in South Korea. Korean National Health Insurance claims data were used as a baseline to develop possible RPS models. Five components of a potential RPS policy were varied: reference groupings, reference pricing methods, co-pay reduction programs, manufacturer price reductions, and increased drug substitutions. The potential changes for prescription ingredient costs and co-payment rates were predicted for the various scenarios. It was predicted that transferring the difference (total price minus reference price) from the insurer to patients would reduce ingredient costs from 1.4% to 22.8% for the third-party payer (government), but patient co-payment rates would increase from a baseline of 20.4% to 22.0% using chemical groupings and to 25.0% using therapeutic groupings. Savings rates in prescription ingredient costs (government and patient combined) were predicted to range from 1.6% to 13.7% depending on various scenarios. Although the co-payment rate would increase, a 15% price reduction by manufacturers coupled with a substitution rate of 30% would result in a decrease in the co-payment amount (change in absolute dollars vs. change in rates). Our models predicted that the implementation of RPS in South Korea would lead to savings in ingredient costs for the third-party payer and co-payments for patients with potential scenarios. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Education as Prescription for Patients with Type 2 Diabetes Mellitus: Compliance and Efficacy in Clinical Practice

Directory of Open Access Journals (Sweden)

Mi Yeon Kim

2012-12-01

Full Text Available BackgroundDiabetes self-management education has an important role in diabetes management. The efficacy of education has been proven in several randomized trials. However, the status of diabetes education programs in real Korean clinical practice has not yet been evaluated in terms of patient compliance with the education prescription.MethodsWe retrospectively analyzed clinical and laboratory data from all patients who were ordered to undergo diabetes education during 2009 at Samsung Medical Center, Seoul, Korea (n=2,291. After excluding ineligible subjects, 588 patients were included in the analysis.ResultsAmong the 588 patients, 433 received education. The overall compliance rate was 73.6%, which was significantly higher in the subjects with a short duration or living in a rural area compared to those with a long duration (85.0% vs. 65.1%, respectively; P<0.001 or living in an urban area (78.2% vs. 70.4%, respectively; P=0.037. The hemoglobin A1c decreased greater in the compliant group (from 7.84±1.54 at baseline to 6.79±1.06 at 3 months and 6.97±1.20 at 12 months after prescription in the compliant group vs. from 7.74±1.25 to 7.14±1.02 and 7.24±1.24 in the non-compliant group; P=0.001. The decrease in hemoglobin A1c was greater in the subjects with a short duration (P=0.032.ConclusionIn our study a large percent of patients refuse to get education despite having a prescription from their physician. This refusal rate was higher in the patients with long-standing diabetes or in urban residence. Furthermore, education was more effective in patients with a short duration of diabetes in clinical practice.

The impact of change in albumin assay on reference intervals, prevalence of 'hypoalbuminaemia' and albumin prescriptions.

Science.gov (United States)

Coley-Grant, Deon; Herbert, Mike; Cornes, Michael P; Barlow, Ian M; Ford, Clare; Gama, Rousseau

2016-01-01

We studied the impact on reference intervals, classification of patients with hypoalbuminaemia and albumin infusion prescriptions on changing from a bromocresol green (BCG) to a bromocresol purple (BCP) serum albumin assay. Passing-Bablok regression analysis and Bland-Altman plot were used to compare Abbott BCP and Roche BCG methods. Linear regression analysis was used to compare in-house and an external laboratory Abbott BCP serum albumin results. Reference intervals for Abbott BCP serum albumin were derived in two different laboratories using pathology data from adult patients in primary care. Prescriptions for 20% albumin infusions were compared one year before and one year after changing the albumin method. Abbott BCP assay had a negative bias of approximately 6 g/L compared with Roche BCG method.There was good agreement (y = 1.04 x - 1.03; R(2 )= 0.9933) between in-house and external laboratory Abbott BCP results. Reference intervals for the serum albumin Abbott BCP assay were 31-45 g/L, different to those recommended by Pathology Harmony and the manufacturers (35-50 g/L). Following the change in method there was a large increase in the number of patients classified as hypoalbuminaemic using Pathology Harmony references intervals (32%) but not when retrospectively compared to locally derived reference intervals (16%) compared with the previous year (12%). The method change was associated with a 44.6% increase in albumin prescriptions. This equated to an annual increase in expenditure of £35,234. We suggest that serum albumin reference intervals be method specific to prevent misclassification of albumin status in patients. Change in albumin methodology may have significant impact on hospital resources. © The Author(s) 2015.

32 CFR 842.95 - Non-assertable claims.

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2010-07-01

... ADMINISTRATIVE CLAIMS Property Damage Tort Claims in Favor of the United States (31 U.S.C. 3701, 3711-3719) § 842...) Reimbursement for military or civilian employees for their negligence claims paid by the United States. (b) Loss...

37 CFR 360.12 - Form and content of claims.

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2010-07-01

... SUBMISSION OF ROYALTY CLAIMS FILING OF CLAIMS TO ROYALTY FEES COLLECTED UNDER COMPULSORY LICENSE Satellite Claims § 360.12 Form and content of claims. (a) Forms. (1) Each claim to compulsory license royalty fees... owner entitled to claim the royalty fees. (ii) A general statement of the nature of the copyright owner...

37 CFR 360.3 - Form and content of claims.

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2010-07-01

... SUBMISSION OF ROYALTY CLAIMS FILING OF CLAIMS TO ROYALTY FEES COLLECTED UNDER COMPULSORY LICENSE Cable Claims § 360.3 Form and content of claims. (a) Forms. (1) Each claim to cable compulsory license royalty fees... copyright owner entitled to claim the royalty fees. (ii) A general statement of the nature of the copyright...

Prescription drugs purchased through the internet: who are the end users?

Science.gov (United States)

Inciardi, James A; Surratt, Hilary L; Cicero, Theodore J; Rosenblum, Andrew; Ahwah, Candice; Bailey, J Elise; Dart, Richard C; Burke, John J

2010-07-01

Although prescription drugs are readily available on the Internet, little is known about the prevalence of Internet use for the purchase of medications without a legitimate prescription, and the characteristics of those that obtain non-prescribed drugs through online sources. The scientific literature on this topic is limited to anecdotal reports or studies plagued by small sample sizes. Within this context, the focus of this paper is an examination of five national data sets from the U.S. with the purpose of estimating: (1) how common obtaining prescription medications from the Internet actually is, (2) who are the typical populations of "end users" of these non-prescribed medications, and (3) which drugs are being purchased without a prescription. Three of the data sets are drawn from the RADARS (Researched Abuse Diversion and Addiction-Related Surveillance) System, a comprehensive series of studies designed to collect timely and geographically specific data on the abuse and diversion of a number of prescription stimulants and opioid analgesics. The remaining data sets include the National Survey on Drug Use and Health (NSDUH) and the Monitoring the Future (MTF) survey. Our analysis yielded uniformly low rates of prescription drug acquisition from online sources across all five data systems we examined. The consistency of this finding across very diverse populations suggests that the Internet is a relatively minor source for illicit purchases of prescription medications by the individual end-users of these drugs. Copyright 2010 Elsevier Ireland Ltd. All rights reserved.

Pharmacy Customers’ Experiences With Electronic Prescriptions: Cross-Sectional Survey on Nationwide Implementation in Finland

Science.gov (United States)

Timonen, Johanna; Ahonen, Riitta

2018-01-01

Background One of the forerunners in electronic health, Finland has introduced electronic prescriptions (ePrescriptions) nationwide by law. This has led to significant changes for pharmacy customers. Despite the worldwide ambition to develop ePrescription services, there are few reports of nationally adopted systems and particularly on the experiences of pharmacy customers. Objective The aim of this study was to investigate Finnish pharmacy customers’ (1) experiences with purchasing medicines with ePrescriptions; (2) experiences with renewing ePrescriptions and acting on behalf of someone else at the pharmacy; (3) ways in which customers keep up to date with their ePrescriptions; and (4) overall satisfaction with ePrescriptions. Methods Questionnaires were distributed to 2913 pharmacy customers aged ≥18 years purchasing prescription medicines for themselves with an ePrescription in 18 community pharmacies across Finland in autumn 2015. Customers’ experiences were explored with 10 structured questions. The data were stored in SPSS for Windows and subjected to descriptive analysis, chi-square, Fisher exact, Kolmogorov-Smirnov, the Mann-Whitney U, and Kruskal-Wallis tests. Results Completed questionnaires were returned by 1288 customers, a response rate of 44.19% (1288/2913). The majority of the respondents did not encounter any problems during pharmacy visits (1161/1278, 90.85%) and were informed about the current status of their ePrescriptions after their medication was dispensed (1013/1276, 79.44%). Over half of the respondents had usually received a patient instruction sheet from their physician (752/1255, 59.92%), and nearly all of them regarded its content as clear (711/724, 98.2%). Half of the respondents had renewed their ePrescriptions through the pharmacy (645/1281, 50.35%), and one-third of them had acted on behalf of someone else with ePrescriptions (432/1280, 33.75%). Problems were rarely encountered in the renewal process (49/628, 7.8%) or when

[Antibiotic prescription usage and assessment in geriatric patients].

Science.gov (United States)

Dinh, Aurélien; Davido, Benjamin; Salomon, Jérôme; Le Quintrec, Jean-Laurent; Teillet, Laurent

2016-01-01

Due to the high risk of infection, the geriatric population is regularly subjected to antibiotics. Faced with bacterial resistance, particularly among elderly dependent patients, it is essential to promote proper use and correct prescription of antibiotics. A study evaluated antibiotic prescription in a geriatric hospital with 598 beds and highlighted the importance of collaboration between geriatricians and infectious disease specialists. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Controversy in Purchasing Prescription Drugs Online in China.

Science.gov (United States)

Yuan, Peng; Qi, Lin; Wang, Long

2016-08-01

China's government is considering legalization of online prescription drugs to increase the pharmaceutical market and enhance access to necessary medicines. However, challenges such as a shortage of licensed pharmacists and drug quality issues have raised concerns and delayed consensus on the proposal. China's government must address the most pressing issues so it can render a decision on online prescription sales. Copyright © 2016 Elsevier Ltd. All rights reserved.

Prescription of anorectic and benzodiazepine drugs through notification B prescriptions in Natal, Rio Grande do Norte, Brazil

Directory of Open Access Journals (Sweden)

Solange Aparecida Nappo

2010-06-01

Full Text Available A study was conducted on 22,158 special B prescriptions (notificações B containing amphetamine-type anorectic drugs or benzodiazepines, obtained from compounding pharmacies or drugstores located in the city of Natal, RN, Brazil. The data obtained were compared with those from other Brazilian cities. Results showed that compounding pharmacies dispensed 85.4% of the prescriptions, indicating that these pharmacies filled out nearly 10 times more of these prescriptions than did the drugstores. The majority (83.5% of B prescriptions issued for the compounding pharmacies were for women, where the female/male patient ratio ranged from 7.1/1.0 for mazindol to 10.3/1.0 for amfepramone. Similar results were obtained for the benzodiazepines with ratios of 1.9/1.0 for clonazepam to 15.6/1.0 for oxazepam. Omissions and mistakes were present in the B prescriptions, including missing information about the patient (in 49.6% of the documents or about the pharmacies or drugstores (50.4%. There were cases where the name and/or CRM of the physician was lacking. It was noted that one medical doctor made out 1855 B prescriptions within one year. The same patient's name appeared on 138 prescriptions, and the same RG (identification card number was present in 125 others. Comparison of Natal's data with those of several other Brazilian cities disclosed a striking similarity throughout Brazil, from Pelotas - Rio Grande do Sul State to Belem-Para State, revealing a practically identical medical/pharmaceutical behavior. This pattern of prescription/dispensation of amphetamine-type substances mostly to women for weight loss is therefore for cosmetic reasons. Consequently, there is an urgent need for an ethical review of this behavior.Foram examinadas 22.158 notificações B contendo substâncias anoréticas tipo-anfetamina ou de benzodiazepínicos, obtidas de drogarias e de farmácias de manipulação. Os dados foram comparados com os de outras cidades do Brasil, obtendo

32 CFR Appendix to Part 281 - Claims Description

Science.gov (United States)

2010-07-01

... advance decision functions for claims under the following statutes: (a) 31 U.S.C. 3702, concerning claims... SETTLING PERSONNEL AND GENERAL CLAIMS AND PROCESSING ADVANCE DECISION REQUESTS Pt. 281, App. Appendix to... Personnel Management performs these functions for claims involving civilian employees' compensation and...

An automated technique to identify potential inappropriate traditional Chinese medicine (TCM) prescriptions.

Science.gov (United States)

Yang, Hsuan-Chia; Iqbal, Usman; Nguyen, Phung Anh; Lin, Shen-Hsien; Huang, Chih-Wei; Jian, Wen-Shan; Li, Yu-Chuan

2016-04-01

Medication errors such as potential inappropriate prescriptions would induce serious adverse drug events to patients. Information technology has the ability to prevent medication errors; however, the pharmacology of traditional Chinese medicine (TCM) is not as clear as in western medicine. The aim of this study was to apply the appropriateness of prescription (AOP) model to identify potential inappropriate TCM prescriptions. We used the association rule of mining techniques to analyze 14.5 million prescriptions from the Taiwan National Health Insurance Research Database. The disease and TCM (DTCM) and traditional Chinese medicine-traditional Chinese medicine (TCMM) associations are computed by their co-occurrence, and the associations' strength was measured as Q-values, which often referred to as interestingness or life values. By considering the number of Q-values, the AOP model was applied to identify the inappropriate prescriptions. Afterwards, three traditional Chinese physicians evaluated 1920 prescriptions and validated the detected outcomes from the AOP model. Out of 1920 prescriptions, 97.1% of positive predictive value and 19.5% of negative predictive value were shown by the system as compared with those by experts. The sensitivity analysis indicated that the negative predictive value could improve up to 27.5% when the model's threshold changed to 0.4. We successfully applied the AOP model to automatically identify potential inappropriate TCM prescriptions. This model could be a potential TCM clinical decision support system in order to improve drug safety and quality of care. Copyright © 2016 John Wiley & Sons, Ltd.

Treatment adherence and persistence with long-acting somatostatin analog therapy for the treatment of acromegaly: a retrospective analysis.

Science.gov (United States)

Gurel, Michelle H; Han, Yi; Stevens, Andrea L; Furtado, Aaron; Cox, David

2017-04-04

Many patients with acromegaly require medical treatment that includes somatostatin analogs (SSAs). Long-acting SSA formulations are widely used, due in part to increased patient convenience and increased treatment adherence vs daily medications. Although medication compliance can be poor in patients with chronic conditions, adherence and persistence with these SSAs in patients with acromegaly has not been evaluated. This analysis utilized claims data to estimate treatment adherence and persistence for lanreotide depot and long-acting octreotide in this population. This retrospective analysis used the MarketScan® database (~100 payors, 500 million claims in the US), which was searched between January 2007 and June 2012 to identify patients with acromegaly taking either lanreotide depot or long-acting octreotide. Patients switching treatments were excluded. Treatment adherence was assessed using medication possession ratio (MPR; number of doses dispensed in relation to dispensing period; ≥80% is considered adherent), injection count, and treatment time. Persistence was estimated by Kaplan-Meier analyses and Cox proportional hazards modeling. A washout period, defined as no acromegaly-related prescription activity 180 days prior to the index date, was employed to minimize effects of prior therapy and focus on patients more likely to be treatment-naïve. Altogether 1308 patients with acromegaly receiving a single SSA for treatment (1127 octreotide, 181 lanreotide) who had not switched treatments were identified. Mean MPR in patients with a 180-day washout (n = 663) was 89% for those receiving octreotide (n = 545) and 87% for those receiving lanreotide (n = 118). Median number of days on therapy was 169 (95% CI 135-232) for octreotide patients and 400 (95% CI 232-532) for lanreotide patients. The point estimate of the Cox proportional hazard ratio for stopping treatment was 1.385 for octreotide vs lanreotide (95% CI 1.079-1.777), suggesting a 38

28 CFR 32.32 - Time for filing claim.

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2010-07-01

... 28 Judicial Administration 1 2010-07-01 2010-07-01 false Time for filing claim. 32.32 Section 32.32 Judicial Administration DEPARTMENT OF JUSTICE PUBLIC SAFETY OFFICERS' DEATH, DISABILITY, AND EDUCATIONAL ASSISTANCE BENEFIT CLAIMS Educational Assistance Benefit Claims § 32.32 Time for filing claim. (a...

Future Challenges and Opportunities in Online Prescription Drug Promotion Research

Science.gov (United States)

Southwell, Brian G.; Rupert, Douglas J.

2016-01-01

Despite increased availability of online promotional tools for prescription drug marketers, evidence on online prescription drug promotion is far from settled or conclusive. We highlight ways in which online prescription drug promotion is similar to conventional broadcast and print advertising and ways in which it differs. We also highlight five key areas for future research: branded drug website influence on consumer knowledge and behavior, interactive features on branded drug websites, mobile viewing of branded websites and mobile advertisements, online promotion and non-US audiences, and social media and medication decisions. PMID:26927597

Trends in direct-to-consumer advertising of prescription contraceptives.

Science.gov (United States)

Wu, Min H; Bartz, Deborah; Avorn, Jerry; Seeger, John D

2016-05-01

Despite much speculation about the role of direct-to-consumer advertising (DTCA) in increasing demand for prescription contraceptives in the United States, there is little published research on this topic. We sought to quantify the prevalence and magnitude of DTCA for prescription contraceptives over the last decade. Using cross-sectional data from January 2005 through December 2014, we performed descriptive analyses on trends in DTCA expenditure for prescription contraceptives. We also quantified the amount of DTCA according to contraceptive method category and individual brand. During the study period, pharmaceutical companies spent a total of US$1.57 billion in the United States on DTCA of prescription contraceptives. Annual expenditure for contraceptive DTCA reached a peak value of US$260 million in 2008, with a progressive decline to a nadir of US$69 million by 2013. Of the contraceptive methods, oral contraceptive pills (OCPs) have been the most heavily promoted, with Yaz (drospirenone/ethinyl estradiol) - the most advertised brand - accounting for US$347 million of cumulative DTCA expenditure. However, DTCA spending on OCPs peaked in 2007 and was overtaken in 2012 by the DTCA of long-acting reversible contraceptives (LARCs), the contraceptive method now receiving the largest amount of DTCA promotion. DTCA is a major form of promotion for prescription contraceptives. Recent trends in DTCA expenditure indicate a shift from promotion of the OCPs to the LARCs. DTCA's effect on provider and patient utilization of various contraceptive methods has yet to be determined. This study provides the first quantitative evaluation of DTCA of prescription contraceptive methods and reveals DTCA's importance as a form of promotion. Recent DTCA trends indicate increased promotion of LARCs, coinciding with greater uptake of LARC methods by patients and prescribers. Copyright © 2016 Elsevier Inc. All rights reserved.

Impact of Internally Developed Electronic Prescription on Prescribing Errors at Discharge from the Emergency Department.

Science.gov (United States)

Hitti, Eveline; Tamim, Hani; Bakhti, Rinad; Zebian, Dina; Mufarrij, Afif

2017-08-01

Medication errors are common, with studies reporting at least one error per patient encounter. At hospital discharge, medication errors vary from 15%-38%. However, studies assessing the effect of an internally developed electronic (E)-prescription system at discharge from an emergency department (ED) are comparatively minimal. Additionally, commercially available electronic solutions are cost-prohibitive in many resource-limited settings. We assessed the impact of introducing an internally developed, low-cost E-prescription system, with a list of commonly prescribed medications, on prescription error rates at discharge from the ED, compared to handwritten prescriptions. We conducted a pre- and post-intervention study comparing error rates in a randomly selected sample of discharge prescriptions (handwritten versus electronic) five months pre and four months post the introduction of the E-prescription. The internally developed, E-prescription system included a list of 166 commonly prescribed medications with the generic name, strength, dose, frequency and duration. We included a total of 2,883 prescriptions in this study: 1,475 in the pre-intervention phase were handwritten (HW) and 1,408 in the post-intervention phase were electronic. We calculated rates of 14 different errors and compared them between the pre- and post-intervention period. Overall, E-prescriptions included fewer prescription errors as compared to HW-prescriptions. Specifically, E-prescriptions reduced missing dose (11.3% to 4.3%, p prescriptions, however, were associated with a significant increase in duplication errors, specifically with home medication (1.7% to 3%, p=0.02). A basic, internally developed E-prescription system, featuring commonly used medications, effectively reduced medication errors in a low-resource setting where the costs of sophisticated commercial electronic solutions are prohibitive.

Technical Note: Dose gradients and prescription isodose in orthovoltage stereotactic radiosurgery

International Nuclear Information System (INIS)

Fagerstrom, Jessica M.; Bender, Edward T.; Culberson, Wesley S.

2016-01-01

Purpose: The purpose of this work is to examine the trade-off between prescription isodose and dose gradients in orthovoltage stereotactic radiosurgery. Methods: Point energy deposition kernels (EDKs) describing photon and electron transport were calculated using Monte Carlo methods. EDKs were generated from 10  to 250 keV, in 10 keV increments. The EDKs were converted to pencil beam kernels and used to calculate dose profiles through isocenter from a 4π isotropic delivery from all angles of circularly collimated beams. Monoenergetic beams and an orthovoltage polyenergetic spectrum were analyzed. The dose gradient index (DGI) is the ratio of the 50% prescription isodose volume to the 100% prescription isodose volume and represents a metric by which dose gradients in stereotactic radiosurgery (SRS) may be evaluated. Results: Using the 4π dose profiles calculated using pencil beam kernels, the relationship between DGI and prescription isodose was examined for circular cones ranging from 4 to 18 mm in diameter and monoenergetic photon beams with energies ranging from 20 to 250 keV. Values were found to exist for prescription isodose that optimize DGI. Conclusions: The relationship between DGI and prescription isodose was found to be dependent on both field size and energy. Examining this trade-off is an important consideration for designing optimal SRS systems.

A microcomputer system for prescription, calculation, verification and recording of radiotherapy treatments

International Nuclear Information System (INIS)

Morrey, D.; Smith, C.W.; Belcher, R.A.; Harding, T.; Sutherland, W.H.

1982-01-01

The design of a microcomputer system for the reduction of mistakes in radiotherapy is described. The system covers prescription entry, prescription and treatment calculations, and verification and recording of the treatment set-up. A telecobalt unit was interfaced to the system and in the first 12 months 400 patients have been prescribed and 5000 treatment fields verified. The prescription is entered by the medical officer using an interactive program and this prescription provides the reference for verifying the treatment set-up. The program allows amendments to the prescription to be made easily during the treatment course. The treatment parameters verified are field size, wedge and treatment time. The system uses bar-codes for patient and field identification. A reduction in the number of mistakes has been achieved and future developments are discussed. (author)

Treatment patterns in hyperlipidaemia patients based on administrative claim databases in Japan.

Science.gov (United States)

Wake, Mayumi; Onishi, Yoshie; Guelfucci, Florent; Oh, Akinori; Hiroi, Shinzo; Shimasaki, Yukio; Teramoto, Tamio

2018-05-01

Real-world evidence on treatment of hyperlipidaemia (HLD) in Japan is limited. We aimed to describe treatment patterns, persistence with, and adherence to treatment in Japanese patients with HLD. Retrospective analyses of adult HLD patients receiving drug therapy in 2014-2015 were conducted using the Japan Medical Data Center (JMDC) and Medical Data Vision (MDV) databases. Depending on their HLD treatment history, individuals were categorised as untreated (UT) or previously treated (PT), and were followed for at least 12 months. Outcomes of interest included prescribing patterns of HLD drug classes, persistence with treatment at 12 months, and adherence to treatment. Data for 49,582 and 53,865 patients from the JMDC and MDV databases, respectively, were analysed. First-line HLD prescriptions for UT patients were predominantly for moderate statins (JMDC: 75.9%, MDV: 77.0%). PT patients most commonly received combination therapy (JMDC: 43.9%, MDV: 52.6%). Approximately half of the UT patients discontinued treatment during observation. Within each cohort, persistence rates were lower in UT patients than in PT patients (JMDC: 45.0% vs. 77.5%; MDV: 51.9% vs. 85.3%). Adherence was ≥80% across almost all HLD drug classes, and was slightly lower in the JMDC cohort than MDV cohort. Most common prescriptions were moderate statins in UT patients and combination therapy in PT patients. The high discontinuation rate of HLD therapy in UT patients warrants further investigation and identification of methods to encourage and support long-term persistence. Copyright © 2018. Published by Elsevier B.V.

Investigating the exercise-prescription practices of nurses working in inpatient mental health settings.

Science.gov (United States)

Stanton, Robert; Happell, Brenda; Reaburn, Peter

2015-04-01

Nurses working in mental health are well positioned to prescribe exercise to people with mental illness. However, little is known regarding their exercise-prescription practices. We examined the self-reported physical activity and exercise-prescription practices of nurses working in inpatient mental health facilities. Thirty-four nurses completed the Exercise in Mental Illness Questionnaire - Health Practitioner Version. Non-parametric bivariate statistics revealed no relationship between nurses' self-reported physical activity participation and the frequency of exercise prescription for people with mental illness. Exercise-prescription parameters used by nurses are consistent with those recommended for both the general population and for people with mental illness. A substantial number of barriers to effective exercise prescription, including lack of training, systemic issues (such as prioritization and lack of time), and lack of consumer motivation, impact on the prescription of exercise for people with mental illness. Addressing the barriers to exercise prescription could improve the proportion of nurses who routinely prescribe exercise. Collaboration with exercise professionals, such as accredited exercise physiologists or physiotherapists, might improve knowledge of evidence-based exercise-prescription practices for people with mental illness, thereby improving both physical and mental health outcomes for this vulnerable population. © 2015 Australian College of Mental Health Nurses Inc.

What does the U.S. Medicare administrative claims database tell us about initial antiepileptic drug treatment for older adults with new-onset epilepsy?

Science.gov (United States)

Martin, Roy C; Faught, Edward; Szaflarski, Jerzy P; Richman, Joshua; Funkhouser, Ellen; Piper, Kendra; Juarez, Lucia; Dai, Chen; Pisu, Maria

2017-04-01

Disparities in epilepsy treatment are not uncommon; therefore, we examined population-based estimates of initial antiepileptic drugs (AEDs) in new-onset epilepsy among racial/ethnic minority groups of older US Medicare beneficiaries. We conducted retrospective analyses of 2008-2010 Medicare administrative claims for a 5% random sample of beneficiaries augmented for minority representation. New-onset epilepsy cases in 2009 had ≥1 International Classification of Diseases, Ninth Revision (ICD-9) 345.x or ≥2 ICD-9 780.3x, and ≥1 AED, AND no seizure/epilepsy claim codes or AEDs in preceding 365 days. We examined AED use and concordance with Quality Indicators of Epilepsy Treatment (QUIET) 6 (monotherapy as initial treatment = ≥30 day first prescription with no other concomitant AEDs), and prompt AED treatment (first AED within 30 days of diagnosis). Logistic regression examined likelihood of prompt treatment by demographic (race/ethnicity, gender, age), clinical (number of comorbid conditions, neurology care, index event occurring in the emergency room (ER)), and economic (Part D coverage phase, eligibility for Part D Low Income Subsidy [LIS], and ZIP code level poverty) factors. Over 1 year of follow-up, 79.6% of 3,706 new epilepsy cases had one AED only (77.89% of whites vs. 89% of American Indian/Alaska Native [AI/AN]). Levetiracetam was the most commonly prescribed AED (45.5%: from 24.6% AI/AN to 55.0% whites). The second most common was phenytoin (30.6%: from 18.8% Asians to 43.1% AI/AN). QUIET 6 concordance was 94.7% (93.9% for whites to 97.3% of AI/AN). Only 50% received prompt AED therapy (49.6% whites to 53.9% AI/AN). Race/ethnicity was not significantly associated with AED patterns, monotherapy use, or prompt treatment. Monotherapy is common across all racial/ethnic groups of older adults with new-onset epilepsy, older AEDs are commonly prescribed, and treatment is frequently delayed. Further studies on reasons for treatment delays are warranted

Diversity of Physicians’ Handwriting and Name Stamp in Chemotherapy Prescriptions: Potential Target for Fraud

Directory of Open Access Journals (Sweden)

Asiyeh Amouei

2018-02-01

Full Text Available BBackgrounds: Verification and authentication of the paper-based handwritten prescriptions is of great importance for antineoplastic medications that are good targets for forgery and fraud. Pharmacists usually investigate handwriting, signature and name stamp of prescribers to verify prescriptions in Iran. Anecdotal reports of variations in handwriting and name stamp of physicians who wrote antineoplastic prescriptions raised concerns in this regard. The aim of the study was to investigate the reported diversity and evaluate the quality of writing physician identity and required items in antineoplastic prescriptions.Methods: All insured hand-written prescriptions contained at least one antineoplastic medication and were dispensed by four main authorized community pharmacies dispensing antineoplastic medications in Tehran during one month were included. Prescriptions that were written by specialties other than oncology-related fields were excluded. Prescriptions of each physician were evaluated considering handwriting and name stamp by experienced pharmacy staff and the frequency of detected handwriting and name stamp types was recorded.Results: Of the 11022 included prescriptions, 10944 were eligible and written by 241 physicians. Median (third quartile number of physicians’ prescriptions was 17 (51. Maximum number of observed handwriting and name stamp types were eight and six respectively. High prescribers tended to have several handwriting and name stamp types.Conclusion: The observed diversity and variation in handwriting and name stamp of the physicians in antineoplastic prescriptions may facilitate the entrance of forged prescription and makes fraud detection difficult. Administrative and regulatory interventions in addition to notification of health care professionals about the observed potential might be necessary.

Comparison of provincial prescription drug plans and the impact on patients' annual drug expenditures.

Science.gov (United States)

Demers, Virginie; Melo, Magda; Jackevicius, Cynthia; Cox, Jafna; Kalavrouziotis, Dimitri; Rinfret, Stéphane; Humphries, Karin H; Johansen, Helen; Tu, Jack V; Pilote, Louise

2008-02-12

Reimbursement for outpatient prescription drugs is not mandated by the Canada Health Act or any other federal legislation. Provincial governments independently establish reimbursement plans. We sought to describe variations in publicly funded provincial drug plans across Canada and to examine the impact of this variation on patients' annual expenditures. We collected information, accurate to December 2006, about publicly funded prescription drug plans from all 10 Canadian provinces. Using clinical scenarios, we calculated the impact of provincial cost-sharing strategies on individual annual drug expenditures for 3 categories of patients with different levels of income and 2 levels of annual prescription burden ($260 and $1000). We found that eligibility criteria and cost-sharing details of the publicly funded prescription drug plans differed markedly across Canada, as did the personal financial burden due to prescription drug costs. Seniors pay 35% or less of their prescription costs in 2 provinces, but elsewhere they may pay as much as 100%. With few exceptions, nonseniors pay more than 35% of their prescription costs in every province. Most social assistance recipients pay 35% or less of their prescription costs in 5 provinces and pay no costs in the other 5. In an example of a patient with congestive heart failure, his out-of-pocket costs for a prescription burden of $1283 varied between $74 and $1332 across the provinces. Considerable interprovincial variation in publicly funded prescription drug plans results in substantial variation in annual expenditures by Canadians with identical prescription burdens. A revised pharmaceutical strategy might reduce these major inequities.

Worst-Case-Optimal Dynamic Reinsurance for Large Claims

DEFF Research Database (Denmark)

Korn, Ralf; Menkens, Olaf; Steffensen, Mogens

2012-01-01

We control the surplus process of a non-life insurance company by dynamic proportional reinsurance. The objective is to maximize expected (utility of the) surplus under the worst-case claim development. In the large claim case with a worst-case upper limit on claim numbers and claim sizes, we fin...

32 CFR 536.29 - Revision of filed claims.

Science.gov (United States)

2010-07-01

... AGAINST THE UNITED STATES Investigation and Processing of Claims § 536.29 Revision of filed claims. (a... the writing alleges a new theory of liability, a new tortfeasor, a new party claimant, a different... amendment, not a new claim. Similarly, the addition of required information not on the original claim...

Pharmacy Customers' Experiences With Electronic Prescriptions: Cross-Sectional Survey on Nationwide Implementation in Finland.

Science.gov (United States)

Lämsä, Elina; Timonen, Johanna; Ahonen, Riitta

2018-02-23

One of the forerunners in electronic health, Finland has introduced electronic prescriptions (ePrescriptions) nationwide by law. This has led to significant changes for pharmacy customers. Despite the worldwide ambition to develop ePrescription services, there are few reports of nationally adopted systems and particularly on the experiences of pharmacy customers. The aim of this study was to investigate Finnish pharmacy customers' (1) experiences with purchasing medicines with ePrescriptions; (2) experiences with renewing ePrescriptions and acting on behalf of someone else at the pharmacy; (3) ways in which customers keep up to date with their ePrescriptions; and (4) overall satisfaction with ePrescriptions. Questionnaires were distributed to 2913 pharmacy customers aged ≥18 years purchasing prescription medicines for themselves with an ePrescription in 18 community pharmacies across Finland in autumn 2015. Customers' experiences were explored with 10 structured questions. The data were stored in SPSS for Windows and subjected to descriptive analysis, chi-square, Fisher exact, Kolmogorov-Smirnov, the Mann-Whitney U, and Kruskal-Wallis tests. Completed questionnaires were returned by 1288 customers, a response rate of 44.19% (1288/2913). The majority of the respondents did not encounter any problems during pharmacy visits (1161/1278, 90.85%) and were informed about the current status of their ePrescriptions after their medication was dispensed (1013/1276, 79.44%). Over half of the respondents had usually received a patient instruction sheet from their physician (752/1255, 59.92%), and nearly all of them regarded its content as clear (711/724, 98.2%). Half of the respondents had renewed their ePrescriptions through the pharmacy (645/1281, 50.35%), and one-third of them had acted on behalf of someone else with ePrescriptions (432/1280, 33.75%). Problems were rarely encountered in the renewal process (49/628, 7.8%) or when acting on behalf of another person (25

A review of geographic variation and Geographic Information Systems (GIS) applications in prescription drug use research.

Science.gov (United States)

Wangia, Victoria; Shireman, Theresa I

2013-01-01

While understanding geography's role in healthcare has been an area of research for over 40 years, the application of geography-based analyses to prescription medication use is limited. The body of literature was reviewed to assess the current state of such studies to demonstrate the scale and scope of projects in order to highlight potential research opportunities. To review systematically how researchers have applied geography-based analyses to medication use data. Empiric, English language research articles were identified through PubMed and bibliographies. Original research articles were independently reviewed as to the medications or classes studied, data sources, measures of medication exposure, geographic units of analysis, geospatial measures, and statistical approaches. From 145 publications matching key search terms, forty publications met the inclusion criteria. Cardiovascular and psychotropic classes accounted for the largest proportion of studies. Prescription drug claims were the primary source, and medication exposure was frequently captured as period prevalence. Medication exposure was documented across a variety of geopolitical units such as countries, provinces, regions, states, and postal codes. Most results were descriptive and formal statistical modeling capitalizing on geospatial techniques was rare. Despite the extensive research on small area variation analysis in healthcare, there are a limited number of studies that have examined geographic variation in medication use. Clearly, there is opportunity to collaborate with geographers and GIS professionals to harness the power of GIS technologies and to strengthen future medication studies by applying more robust geospatial statistical methods. Copyright © 2013 Elsevier Inc. All rights reserved.

Pharmaceutical interventions on prescription problems in a Danish pharmacy setting

DEFF Research Database (Denmark)

Pottegård, Anton; Hallas, Jesper; Søndergaard, Jens

2011-01-01

International studies regarding pharmacists' interventions towards prescription problems produce highly variable results. The only peer-reviewed study in a Danish setting estimated an intervention rate of 2.3 per 1,000 prescriptions. With the introduction of a new tool for registration, we...

20 CFR 410.232 - Withdrawal of a claim.

Science.gov (United States)

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Withdrawal of a claim. 410.232 Section 410.232 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL COAL MINE HEALTH AND SAFETY ACT OF 1969... Claims and Evidence § 410.232 Withdrawal of a claim. (a) Before adjudication of claim. A claimant (or an...

A security and privacy preserving e-prescription system based on smart cards.

Science.gov (United States)

Hsu, Chien-Lung; Lu, Chung-Fu

2012-12-01

In 2002, Ateniese and Medeiros proposed an e-prescription system, in which the patient can store e-prescription and related information using smart card. Latter, Yang et al. proposed a novel smart-card based e-prescription system based on Ateniese and Medeiros's system in 2004. Yang et al. considered the privacy issues of prescription data and adopted the concept of a group signature to provide patient's privacy protection. To make the e-prescription system more realistic, they further applied a proxy signature to allow a patient to delegate his signing capability to other people. This paper proposed a novel security and privacy preserving e-prescription system model based on smart cards. A new role, chemist, is included in the system model for settling the medicine dispute. We further presented a concrete identity-based (ID-based) group signature scheme and an ID-based proxy signature scheme to realize the proposed model. Main property of an ID-based system is that public key is simple user's identity and can be verified without extra public key certificates. Our ID-based group signature scheme can allow doctors to sign e-prescription anonymously. In a case of a medical dispute, identities of the doctors can be identified. The proposed ID-based proxy signature scheme can improve signing delegation and allows a delegation chain. The proposed e-prescription system based on our proposed two cryptographic schemes is more practical and efficient than Yang et al.'s system in terms of security, communication overheads, computational costs, practical considerations.

27 CFR 70.608 - Action on claims.

Science.gov (United States)